Provider Demographics
NPI:1205381068
Name:BDR ANESTHESIA, LLC
Entity Type:Organization
Organization Name:BDR ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE-MEMBER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:REBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-847-5385
Mailing Address - Street 1:PO BOX 10224
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92838-6224
Mailing Address - Country:US
Mailing Address - Phone:808-847-5385
Mailing Address - Fax:808-847-5387
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2402
Practice Address - Country:US
Practice Address - Phone:808-847-5385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI18643207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty