Provider Demographics
NPI:1093890097
Name:TEMPLETON, BRADLEY DAVIS (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DAVIS
Last Name:TEMPLETON
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:PO BOX 1348
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-1348
Mailing Address - Country:US
Mailing Address - Phone:336-667-5296
Mailing Address - Fax:336-667-0864
Practice Address - Street 1:702 13TH ST
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4075
Practice Address - Country:US
Practice Address - Phone:336-667-5296
Practice Address - Fax:336-667-0864
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1263287OtherUNITED MINE WORKERS
NC82392OtherBCBSNC
P00188116OtherRAILROAD MEDICARE
NC8982392Medicaid
3429OtherPARTNERS
3444456OtherCIGNA
0407426OtherUNITED HEALTHCARE
202399BMedicare ID - Type Unspecified
3444456OtherCIGNA
P00188116OtherRAILROAD MEDICARE