Provider Demographics
NPI:1649214842
Name:PRICE, BRADLEY B (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:B
Last Name:PRICE
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 1:2911 MEDICAL ARTS ST STE 6
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3302
Mailing Address - Country:US
Mailing Address - Phone:512-476-6691
Mailing Address - Fax:512-476-5607
Practice Address - Street 1:2911 MEDICAL ARTS ST.
Practice Address - Street 2:BLDG 6
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705
Practice Address - Country:US
Practice Address - Phone:512-476-6691
Practice Address - Fax:512-476-5607
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3630207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T988OtherBCBS NUMBER
TXC20690Medicare UPIN
TX00T988Medicare ID - Type UnspecifiedMEDICARE NUMBER