Provider Demographics
NPI:1386648988
Name:COLLETT, BRADLEY SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:SCOTT
Last Name:COLLETT
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:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-0432
Mailing Address - Country:US
Mailing Address - Phone:606-218-3516
Mailing Address - Fax:606-218-4540
Practice Address - Street 1:911 BYPASS RD BLDG A
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1689
Practice Address - Country:US
Practice Address - Phone:606-218-3516
Practice Address - Fax:606-218-4540
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070211A2085R0001X
OH350979802085R0001X
KY388472085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2288OtherMEDICARE GROUP PTAN
KYP00987179OtherMEDICARE RAILROAD
IN201034390Medicaid
5732211OtherBLUE CROSS BLUE SHIELD GROUP ID
KY64087869Medicaid
IL036119025Medicaid
ILDP2506OtherRAILROAD MEDICARE GROUP PTAN
INP00987175OtherMEDICARE RAILROAD
OH0056084Medicaid
ILP00741224OtherRAILROAD MEDICARE
OH0056084Medicaid
INP00987175OtherMEDICARE RAILROAD
ILP00741224OtherRAILROAD MEDICARE
KYK030970Medicare PIN
IL036119025Medicaid
ILK44522Medicare PIN