Provider Demographics
NPI:1285631382
Name:TODD, BRADLEY P (DPM)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:P
Last Name:TODD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3367 GALT OCEAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5968
Mailing Address - Country:US
Mailing Address - Phone:954-566-2580
Mailing Address - Fax:954-566-8929
Practice Address - Street 1:3367 GALT OCEAN DRIVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7002
Practice Address - Country:US
Practice Address - Phone:954-566-2580
Practice Address - Fax:954-566-8929
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3045213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340373400Medicaid
FL340373400Medicaid
FL65799AMedicare ID - Type Unspecified