Provider Demographics
NPI:1407053804
Name:BRASK, BRADLEY (R)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:BRASK
Suffix:
Gender:M
Credentials:R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 N CENTRAL AVE
Mailing Address - Street 2:SUITE 170-284
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2322
Mailing Address - Country:US
Mailing Address - Phone:307-690-0420
Mailing Address - Fax:
Practice Address - Street 1:2 N CENTRAL AVE
Practice Address - Street 2:SUITE 170-284
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2322
Practice Address - Country:US
Practice Address - Phone:307-690-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist