Provider Demographics
NPI:1164519443
Name:REEDY, BRAD J (DO)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:J
Last Name:REEDY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3260 E WOODMEN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3587
Mailing Address - Country:US
Mailing Address - Phone:719-262-0852
Mailing Address - Fax:719-262-0853
Practice Address - Street 1:3260 E WOODMEN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3587
Practice Address - Country:US
Practice Address - Phone:719-262-0852
Practice Address - Fax:719-262-0853
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40494207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H67878Medicare UPIN
472858Medicare ID - Type Unspecified
800650Medicare ID - Type Unspecified