Provider Demographics
NPI:1477645570
Name:AYLOR, BRADLEY (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:AYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:925 HIGHLAND BLVD, SUITE 1130
Mailing Address - Street 2:MONTANA SPORT AND SPINE LLC
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6900
Mailing Address - Country:US
Mailing Address - Phone:406-522-9067
Mailing Address - Fax:406-522-9074
Practice Address - Street 1:925 HIGHLAND BLVD, SUITE 1130
Practice Address - Street 2:MONTANA SPORT AND SPINE LLC
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6900
Practice Address - Country:US
Practice Address - Phone:406-522-9067
Practice Address - Fax:406-522-9074
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MT103812081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000084400Medicare ID - Type Unspecified
MTF64324Medicare UPIN