Provider Demographics
NPI:1477998672
Name:BRADLEY, LAURA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 WEST SPRING CREEK PARKWAY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024
Mailing Address - Country:US
Mailing Address - Phone:469-240-1866
Mailing Address - Fax:972-519-0391
Practice Address - Street 1:5425 W SPRING CREEK PKWY STE 280
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4321
Practice Address - Country:US
Practice Address - Phone:469-240-1866
Practice Address - Fax:972-519-0391
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10046305207V00000X
TXR2542207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty