Provider Demographics
NPI:1487636825
Name:SEELY, BRADLEY H (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:H
Last Name:SEELY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2750 WEST HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2608
Mailing Address - Country:US
Mailing Address - Phone:541-673-8988
Mailing Address - Fax:541-672-8103
Practice Address - Street 1:341 MEDICAL LOOP
Practice Address - Street 2:STE 120
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-5546
Practice Address - Country:US
Practice Address - Phone:541-440-6388
Practice Address - Fax:541-672-0665
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD17071207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR024286Medicaid
OR024286Medicaid
ORR018WFBPGAMedicare PIN