Provider Demographics
NPI:1083616916
Name:SHIPMAN, BRADLEY NEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:NEAL
Last Name:SHIPMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRADLEY
Other - Middle Name:NEAL
Other - Last Name:SHIPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:999 E BASSE RD
Mailing Address - Street 2:SUITE 180, BOX 477
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209
Mailing Address - Country:US
Mailing Address - Phone:210-824-3130
Mailing Address - Fax:210-579-3775
Practice Address - Street 1:250 W SUNSET RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2651
Practice Address - Country:US
Practice Address - Phone:210-824-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2175174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG77898Medicare UPIN
TX365267ZJGJMedicare PIN