Provider Demographics
NPI:1669447488
Name:NICOL, BRADLEY ROBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:ROBERT
Last Name:NICOL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:823 N SAN FRANCISCO ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001
Mailing Address - Country:US
Mailing Address - Phone:928-226-7667
Mailing Address - Fax:928-226-7664
Practice Address - Street 1:823 N SAN FRANCISCO ST
Practice Address - Street 2:SUITE F
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-226-7667
Practice Address - Fax:928-226-7664
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2023-08-22
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Provider Licenses
StateLicense IDTaxonomies
AZ30127207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ701690Medicaid
Z70297Medicare ID - Type Unspecified
AZ701690Medicaid