Provider Demographics
NPI:1073717849
Name:MARKER, BRADLEY TYLER (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:TYLER
Last Name:MARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 W MAIN ST
Mailing Address - Street 2:SUITE 24
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1054
Mailing Address - Country:US
Mailing Address - Phone:334-793-1534
Mailing Address - Fax:334-793-6840
Practice Address - Street 1:4300 W MAIN ST
Practice Address - Street 2:SUITE 24
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1054
Practice Address - Country:US
Practice Address - Phone:334-793-1534
Practice Address - Fax:334-793-6840
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.29548208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP1-0017854OtherINSTITUTIONAL PERMIT