Provider Demographics
NPI:1366445991
Name:TRAN, BRADLEY M (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:M
Last Name:TRAN
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 1:4085 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4357
Mailing Address - Country:US
Mailing Address - Phone:904-448-4180
Mailing Address - Fax:904-448-4184
Practice Address - Street 1:4085 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4357
Practice Address - Country:US
Practice Address - Phone:904-448-4180
Practice Address - Fax:904-448-4184
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60531174400000X
NMMD2014-0144208100000X
FLME122131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00085800OtherMEDICARE RAILROAD
CAP00085800OtherMEDICARE RAILROAD
CAWA60531AMedicare ID - Type Unspecified