Provider Demographics
NPI:1356870620
Name:LANDRUM, BRAD TAYLOR (MD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:TAYLOR
Last Name:LANDRUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9819 EDGECOVE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-1535
Mailing Address - Country:US
Mailing Address - Phone:817-793-0513
Mailing Address - Fax:972-990-3900
Practice Address - Street 1:400 W LYNDON B JOHNSON FWY STE 130
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3700
Practice Address - Country:US
Practice Address - Phone:972-990-5222
Practice Address - Fax:972-990-3900
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2023-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXS00012083P0011X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine