Provider Demographics
NPI:1447241021
Name:WARGO, BRADLEY W (DO)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:W
Last Name:WARGO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 AVALON AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2857
Mailing Address - Country:US
Mailing Address - Phone:256-386-1490
Mailing Address - Fax:
Practice Address - Street 1:203 AVALON AVE STE 120
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2857
Practice Address - Country:US
Practice Address - Phone:256-386-1490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3204207LP2900X, 208VP0014X, 207L00000X
NE422207LP2900X, 208VP0014X
KY03152207LP2900X, 208VP0014X, 207L00000X
IL036.122202207LP2900X, 208VP0014X
IA4210207LP2900X, 208VP0014X
MS24927207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine