Provider Demographics
NPI:1972560423
Name:NORDYKE, BRADLEY WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:WILLIAM
Last Name:NORDYKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:191 E PRICE RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3527
Mailing Address - Country:US
Mailing Address - Phone:956-621-3593
Mailing Address - Fax:956-621-3689
Practice Address - Street 1:191 E PRICE RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3527
Practice Address - Country:US
Practice Address - Phone:956-621-3593
Practice Address - Fax:956-621-3689
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7115208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1269698-03Medicaid
TX1269698-04Medicaid
TX1F0206OtherMEDICARE - MAOB
TX126969811OtherMEDICAID - MAOB