Provider Demographics
NPI:1619603644
Name:VOGEL, BRADFORD W II
Entity Type:Individual
Prefix:MR
First Name:BRADFORD
Middle Name:W
Last Name:VOGEL
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 SELIN CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4218
Mailing Address - Country:US
Mailing Address - Phone:951-331-9153
Mailing Address - Fax:
Practice Address - Street 1:60 BUCKEYE RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3000
Practice Address - Country:US
Practice Address - Phone:951-331-9153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman