Provider Demographics
NPI:1134118334
Name:CONTI, BRADLEY RICHARD (PA)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:RICHARD
Last Name:CONTI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5147 N 9TH AVE
Mailing Address - Street 2:SUITE 322
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8710
Mailing Address - Country:US
Mailing Address - Phone:850-474-9995
Mailing Address - Fax:850-477-6021
Practice Address - Street 1:5147 N 9TH AVE
Practice Address - Street 2:SUITE 322
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8710
Practice Address - Country:US
Practice Address - Phone:850-474-9995
Practice Address - Fax:850-477-6021
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103690363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292018200Medicaid
AL009976465Medicaid
AL009976465Medicaid
FL292018200Medicaid
FLU3850AMedicare PIN