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NPI Code Detail

MEDICARE: DR. BRADLEY WILLIAM NORDYKE M.D.

MEDICARE: DR. BRADLEY WILLIAM NORDYKE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice PhysicianJ7115TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
31F0206OTHERTXMEDICARE - MAOB

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972560423
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRADLEY WILLIAM NORDYKE M.D.
Provider Business Mailing Address
First Line : 191 E PRICE RD
Second Line :
City : BROWNSVILLE
State : TX
Zip : 78521-3527
Country : US
Telephone Number : 956-621-3593
Fax Number : 956-621-3689
Provider Business Practice Location Address
First Line : 191 E PRICE RD
Second Line :
City : BROWNSVILLE
State : TX
Zip : 78521-3527
Country : US
Telephone Number : 956-621-3593
Fax Number : 956-621-3689
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2006
Last Update Date : 12/06/2021

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