Provider Demographics
NPI:1760491039
Name:SPIEGEL, BRADLEY I (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:I
Last Name:SPIEGEL
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 1:415 EAST ROLLING OAKS DRIVE
Mailing Address - Street 2:SUITE#115
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1036
Mailing Address - Country:US
Mailing Address - Phone:805-230-3166
Mailing Address - Fax:602-298-2686
Practice Address - Street 1:415 EAST ROLLING OAKS DRIVE
Practice Address - Street 2:SUITE#115
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1036
Practice Address - Country:US
Practice Address - Phone:805-230-3166
Practice Address - Fax:602-298-2686
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62100207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0052480Medicaid
CAGR0052481Medicaid
CAOOG621000Medicaid
CA00G621001Medicaid
CAG62100DMedicare PIN
F06892Medicare UPIN
CAG62100EMedicare PIN