Provider Demographics
NPI:1295783967
Name:BRADENTON NEUROLOGY INC
Entity type:Organization
Organization Name:BRADENTON NEUROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:MCELVEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-746-3115
Mailing Address - Street 1:PO BOX 9349
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34206-9349
Mailing Address - Country:US
Mailing Address - Phone:941-746-3115
Mailing Address - Fax:941-746-3201
Practice Address - Street 1:3930 8TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-1702
Practice Address - Country:US
Practice Address - Phone:941-746-3115
Practice Address - Fax:941-746-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24609Medicare ID - Type UnspecifiedMEDICARE GROUP