Provider Demographics
NPI:1639321615
Name:WEBB, BRADLEY THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:THOMAS
Last Name:WEBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9500 MENTOR AVENUE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060
Mailing Address - Country:US
Mailing Address - Phone:440-352-1711
Mailing Address - Fax:440-352-7562
Practice Address - Street 1:9500 MENTOR AVENUE
Practice Address - Street 2:SUITE 210
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060
Practice Address - Country:US
Practice Address - Phone:440-352-1711
Practice Address - Fax:440-352-7562
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.015220207X00000X
OH35122917207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery