Provider Demographics
NPI:1356370852
Name:KRADEL, BRIAN KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KEITH
Last Name:KRADEL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 GULF AIRE DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-6123
Mailing Address - Country:US
Mailing Address - Phone:850-866-6444
Mailing Address - Fax:
Practice Address - Street 1:726 GULF AIRE DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-6123
Practice Address - Country:US
Practice Address - Phone:850-866-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA54323207L00000X
NV12932207L00000X
FLME63649207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ47962OtherMEDICAL LICENSE
FL23364OtherFL BC/BS
FL23364OtherFL BC/BS
FL23364ZMedicare ID - Type UnspecifiedPANHANDLE ANESTHESIA