Provider Demographics
NPI:1801998844
Name:BRADLEY, ROBERT H (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2065 E SOUTH BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2463
Mailing Address - Country:US
Mailing Address - Phone:334-281-6990
Mailing Address - Fax:337-281-9725
Practice Address - Street 1:2065 E SOUTH BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2463
Practice Address - Country:US
Practice Address - Phone:334-281-6990
Practice Address - Fax:337-281-9725
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00014647207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000080959BRAMedicaid
AL80959Medicare ID - Type Unspecified
AL000080959BRAMedicaid