Provider Demographics
NPI:1508877564
Name:BROWN, BRADLEY DON (MD)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:DON
Last Name:BROWN
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 1:2700 CLARE AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3330
Mailing Address - Country:US
Mailing Address - Phone:360-479-6555
Mailing Address - Fax:360-479-8327
Practice Address - Street 1:2700 CLARE AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3330
Practice Address - Country:US
Practice Address - Phone:360-479-6555
Practice Address - Fax:360-479-8327
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000337402085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8197824Medicaid
WAB008OtherTRICARE
WABR1084OtherBLUE SHIELD
WABR1084OtherBLUE SHIELD