Provider Demographics
NPI:1184725624
Name:KEITH, BRADLEY J (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
Last Name:KEITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:337 EL DORADO ST
Mailing Address - Street 2:SUITE A3
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4647
Mailing Address - Country:US
Mailing Address - Phone:831-649-4202
Mailing Address - Fax:831-649-0458
Practice Address - Street 1:337 EL DORADO ST
Practice Address - Street 2:STE A3
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-649-4202
Practice Address - Fax:831-649-0458
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-01-18
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Provider Licenses
StateLicense IDTaxonomies
CAG560880207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1184725624OtherNPI
CAGR00761410Medicaid
CACL087YMedicare PIN
CA1184725624OtherNPI
CA00G560880Medicare PIN