Provider Demographics
NPI:1740357524
Name:PITTMAN, BRADLEY KENT (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:KENT
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7495 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-8002
Mailing Address - Country:US
Mailing Address - Phone:303-761-1977
Mailing Address - Fax:303-343-0247
Practice Address - Street 1:3292 PEORIA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-1517
Practice Address - Country:US
Practice Address - Phone:303-761-1977
Practice Address - Fax:303-434-0247
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD067878L207Q00000X
TXP4369207Q00000X
CODR.0072652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX307463503Medicaid
CODR.0072652Medicaid
TX307463502Medicaid