Provider Demographics
NPI:1962815340
Name:R&R 1 LLC
Entity Type:Organization
Organization Name:R&R 1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-718-7276
Mailing Address - Street 1:9272 CADDYSHACK CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1932
Mailing Address - Country:US
Mailing Address - Phone:314-718-7276
Mailing Address - Fax:
Practice Address - Street 1:2071 GOOSE LAKE RD
Practice Address - Street 2:
Practice Address - City:SAUGET
Practice Address - State:IL
Practice Address - Zip Code:62206-2822
Practice Address - Country:US
Practice Address - Phone:618-857-2634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036127269207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty