Provider Demographics
NPI:1477110898
Name:MUNCY, BRADLEY RAYMOND
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:RAYMOND
Last Name:MUNCY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 N BUSINESS DR STE 104
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5287
Mailing Address - Country:US
Mailing Address - Phone:479-521-1532
Mailing Address - Fax:
Practice Address - Street 1:3715 N BUSINESS DR STE 104
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5287
Practice Address - Country:US
Practice Address - Phone:479-521-1532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator