Provider Demographics
NPI:1508872458
Name:BRADY, ALBERT MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:MICHAEL
Last Name:BRADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 996
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-0996
Mailing Address - Country:US
Mailing Address - Phone:208-664-4026
Mailing Address - Fax:208-664-4840
Practice Address - Street 1:3911 CASTLEVALE ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7807
Practice Address - Country:US
Practice Address - Phone:509-454-9499
Practice Address - Fax:509-457-4994
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00044836207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8421083Medicaid
WA8421803Medicaid
WA8421803Medicaid
WAG8857843Medicare PIN