Provider Demographics
NPI:1649245549
Name:DYE, BRADFORD J III (MD)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:J
Last Name:DYE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:497 AZALEA DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-7905
Mailing Address - Country:US
Mailing Address - Phone:662-234-1337
Mailing Address - Fax:662-236-3325
Practice Address - Street 1:497 AZALEA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-7905
Practice Address - Country:US
Practice Address - Phone:662-234-1337
Practice Address - Fax:662-236-3325
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS14950207Y00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121570Medicaid
MS02653Medicare ID - Type UnspecifiedCLINIC CODE
MSH08915Medicare UPIN