Provider Demographics
NPI:1972511293
Name:EAMES, BRADLEY J (DO)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
Last Name:EAMES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1108
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-8108
Mailing Address - Country:US
Mailing Address - Phone:254-694-5092
Mailing Address - Fax:254-694-7039
Practice Address - Street 1:508 WOODSTREAM PL
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-5874
Practice Address - Country:US
Practice Address - Phone:254-694-5092
Practice Address - Fax:254-694-7039
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0319207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8B9213Medicare ID - Type Unspecified
TXA66242Medicare UPIN
TX82461FMedicare ID - Type UnspecifiedMEDICARE