Provider Demographics
NPI:1245432079
Name:WILLIAMS, BRADLEY L (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:L
Last Name:WILLIAMS
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 1:234 E. GRAY STREET
Mailing Address - Street 2:SUITE 850
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1901
Mailing Address - Country:US
Mailing Address - Phone:502-585-1735
Mailing Address - Fax:502-526-5489
Practice Address - Street 1:234 E. GRAY STREET
Practice Address - Street 2:SUITE 850
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1901
Practice Address - Country:US
Practice Address - Phone:502-585-1735
Practice Address - Fax:502-526-5489
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01076129A2085R0202X
KY408432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201334210Medicaid
KY7100017740Medicaid
KY7100017740Medicaid