Provider Demographics
NPI:1760496756
Name:ORRIS, BRADLEY G (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:G
Last Name:ORRIS
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 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-890-2000
Mailing Address - Fax:317-859-4269
Practice Address - Street 1:679 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1049
Practice Address - Country:US
Practice Address - Phone:317-859-7222
Practice Address - Fax:317-859-7220
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061840A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200816990Medicaid
IN000000479447OtherANTHEM PROVIDER NUMBER
IN000000479447OtherANTHEM PROVIDER NUMBER
IN100194370OtherMEDICAID GROUP NUMBER
INP00327866OtherMEDICARE RAILROAD
IN1487680518OtherGROUP NPI NUMBER
IN200816990Medicaid
IN677730DDDMedicare PIN
IN145840JMedicare PIN