Provider Demographics
NPI:1578542320
Name:BRADY, BRIDGET MARIE (MD)
Entity Type:Individual
Prefix:MISS
First Name:BRIDGET
Middle Name:MARIE
Last Name:BRADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 GARNER AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2133
Mailing Address - Country:US
Mailing Address - Phone:512-590-4140
Mailing Address - Fax:
Practice Address - Street 1:3107 OAK CREEK DR STE 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727
Practice Address - Country:US
Practice Address - Phone:512-887-3187
Practice Address - Fax:512-887-3197
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3588208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C0757Medicare PIN