Provider Demographics
NPI:1497700603
Name:MUSSER, BRADLEY J (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:MUSSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 E PRESIDENT GEORGE BUSH HWY STE 306
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4277
Mailing Address - Country:US
Mailing Address - Phone:972-792-7300
Mailing Address - Fax:972-792-7309
Practice Address - Street 1:2821 E PRESIDENT GEORGE BUSH HWY STE 306
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4277
Practice Address - Country:US
Practice Address - Phone:972-792-7300
Practice Address - Fax:972-792-7309
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2968207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047428003Medicaid
TXTXB146714Medicare PIN
TX8K1274Medicare PIN
TXG46104Medicare UPIN