Provider Demographics
NPI:1740210350
Name:BRADLEY, RICHARD NEVILLE (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:NEVILLE
Last Name:BRADLEY
Suffix:
Gender:M
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:PO BOX 842124
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-0032
Mailing Address - Country:US
Mailing Address - Phone:713-208-7168
Mailing Address - Fax:
Practice Address - Street 1:701 SAN JACINTO ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77052-6801
Practice Address - Country:US
Practice Address - Phone:346-272-5770
Practice Address - Fax:713-718-4228
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3688207P00000X, 207PE0004X
CAK36882083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117751103Medicaid
TX82488FOtherBCBS
TX117751104OtherCSHCN
TX82488FOtherBCBS
TX117751104OtherCSHCN
TX82488FMedicare PIN