Provider Demographics
NPI:1629029160
Name:CASE, BRAD ALAN (MD)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:ALAN
Last Name:CASE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2478 PATTERSON ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505
Mailing Address - Country:US
Mailing Address - Phone:970-773-1946
Mailing Address - Fax:970-644-5399
Practice Address - Street 1:2478 PATTERSON RD
Practice Address - Street 2:SUITE 4
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-3605
Practice Address - Country:US
Practice Address - Phone:970-773-1946
Practice Address - Fax:970-644-5399
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2016-08-20
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Provider Licenses
StateLicense IDTaxonomies
FLME00759902086S0129X, 208600000X
FLME75990208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254595100Medicaid
FLK1201Medicare PIN
FLK1201Medicare ID - Type Unspecified
FLG72568Medicare UPIN