Provider Demographics
NPI:1982644696
Name:HART, BRADLEY J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
Last Name:HART
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 1:5425 W SPRING CREEK PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4236
Mailing Address - Country:US
Mailing Address - Phone:972-665-6501
Mailing Address - Fax:
Practice Address - Street 1:301 N PRESTON RD STE D
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8878
Practice Address - Country:US
Practice Address - Phone:469-750-2277
Practice Address - Fax:469-750-2886
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3575208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1828626-01Medicaid
TX8W0853OtherBC/BS OF TEXAS
TX8W0853OtherBC/BS OF TEXAS
TX8G5426Medicare PIN
TX8G5424Medicare PIN
TXP00344893Medicare PIN
TX1828626-01Medicaid