Provider Demographics
NPI:1669978797
Name:BRADLEY, HALLIE (MD)
Entity type:Individual
Prefix:DR
First Name:HALLIE
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 MATLOCK RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-3604
Mailing Address - Country:US
Mailing Address - Phone:817-419-0303
Mailing Address - Fax:833-626-1951
Practice Address - Street 1:76 REGENCY PKWY
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7816
Practice Address - Country:US
Practice Address - Phone:817-419-0303
Practice Address - Fax:833-626-1951
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV0695207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma