Provider Demographics
NPI:1568471845
Name:BRADLEY I. SPIEGEL, M.D., INC.
Entity Type:Organization
Organization Name:BRADLEY I. SPIEGEL, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:I
Authorized Official - Last Name:SPIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-370-4782
Mailing Address - Street 1:415 ROLLING OAKS DRIVE
Mailing Address - Street 2:SUITE#115
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1030
Mailing Address - Country:US
Mailing Address - Phone:805-370-4782
Mailing Address - Fax:805-230-1107
Practice Address - Street 1:415 ROLLING OAKS DRIVE
Practice Address - Street 2:SUITE#115
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1030
Practice Address - Country:US
Practice Address - Phone:805-370-4782
Practice Address - Fax:805-230-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62100207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0052480Medicaid
CAG62100DMedicaid
CAGR0052481Medicaid
CAW21554Medicare PIN
CAGR0052480Medicaid