Provider Demographics
NPI:1053686741
Name:BRADLEY B. PRICE MD PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:BRADLEY B. PRICE MD PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-476-6691
Mailing Address - Street 1:2911 MEDICAL ARTS ST STE 6
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3302
Mailing Address - Country:US
Mailing Address - Phone:512-476-6691
Mailing Address - Fax:512-476-6691
Practice Address - Street 1:2911 MEDICAL ARTS ST STE 6
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3302
Practice Address - Country:US
Practice Address - Phone:512-476-6691
Practice Address - Fax:512-476-5607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3630174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty