Provider Demographics
NPI:1851320691
Name:SOMER, BRADLEY G (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:G
Last Name:SOMER
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 1:7714 POPLAR AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3941
Mailing Address - Country:US
Mailing Address - Phone:901-683-0055
Mailing Address - Fax:901-685-9718
Practice Address - Street 1:7945 WOLF RIVER BLVD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1762
Practice Address - Country:US
Practice Address - Phone:901-683-0055
Practice Address - Fax:901-685-9718
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36133207RH0003X
ARE3985207RH0003X
MS17818207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146833001Medicaid
MO205870603Medicaid
TN3874769Medicaid
TN7245384OtherAETNA
MS00126193Medicaid
TN4038861OtherBCBS TN
AR99243OtherBCBS AR
MO205870603Medicaid
TN3874769Medicaid
MSP00361153Medicare PIN
TN3874769Medicare PIN
TN110237430Medicare PIN