Provider Demographics
NPI:1811182199
Name:SMALL, MICHAEL BRADLEY (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRADLEY
Last Name:SMALL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-532-1355
Mailing Address - Fax:813-635-2613
Practice Address - Street 1:4211 VAN DYKE RD
Practice Address - Street 2:#200
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-8005
Practice Address - Country:US
Practice Address - Phone:813-264-6490
Practice Address - Fax:813-443-8143
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2021-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME104627207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003017701Medicaid