Provider Demographics
NPI:1205360666
Name:GREEN, BRADLEY STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:STEPHEN
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1026 GOODYEAR AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1194
Mailing Address - Country:US
Mailing Address - Phone:256-492-8256
Mailing Address - Fax:256-492-8271
Practice Address - Street 1:1026 GOODYEAR AVE STE 100
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1194
Practice Address - Country:US
Practice Address - Phone:256-492-8256
Practice Address - Fax:256-492-8271
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALMD42493207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106074300Medicaid