Provider Demographics
NPI:1073793899
Name:MOODY, BRAD ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:ROBERT
Last Name:MOODY
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 1:1930 AL HIGHWAY 157
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0609
Mailing Address - Country:US
Mailing Address - Phone:256-734-7850
Mailing Address - Fax:256-734-9633
Practice Address - Street 1:1930 AL HIGHWAY 157
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0609
Practice Address - Country:US
Practice Address - Phone:256-734-7850
Practice Address - Fax:256-734-9633
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30032208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5114925OtherBLUE CROSS AND BLUE SHIELD
AL118130Medicaid
AL118130Medicaid
ALE869Medicare PIN