Provider Demographics
NPI:1639179740
Name:BILTON, BRADLEY DAVID (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DAVID
Last Name:BILTON
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 1:701 UNIVERSITY BLVD E
Mailing Address - Street 2:SUITE 606
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-2086
Mailing Address - Country:US
Mailing Address - Phone:205-752-2501
Mailing Address - Fax:205-759-2868
Practice Address - Street 1:701 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE 606
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2086
Practice Address - Country:US
Practice Address - Phone:205-752-2501
Practice Address - Fax:205-759-2868
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24098208600000X
AL2408208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000003383Medicaid
GT23115Medicare UPIN
AL000003383Medicare ID - Type Unspecified