Provider Demographics
NPI:1467465716
Name:BRADY, JEFFREY R (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:BRADY
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:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-7000
Mailing Address - Fax:515-643-7001
Practice Address - Street 1:25 W HICKMAN RD
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-5018
Practice Address - Country:US
Practice Address - Phone:515-643-7000
Practice Address - Fax:515-643-7001
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02248207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5038018Medicaid
IA00527Medicare ID - Type Unspecified
IAA03467Medicare UPIN