Provider Demographics
NPI:1841293909
Name:BRADY, ALFRED B JR (MD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:B
Last Name:BRADY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:755 N 11TH ST
Mailing Address - Street 2:STE P2200
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1500
Mailing Address - Country:US
Mailing Address - Phone:409-892-1192
Mailing Address - Fax:409-924-9012
Practice Address - Street 1:755 N 11TH ST
Practice Address - Street 2:STE P2200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1500
Practice Address - Country:US
Practice Address - Phone:409-892-1192
Practice Address - Fax:409-924-9012
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD3567207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0473832OtherAETNA ID
TX1338246Medicaid
TX76-0091070OtherOTHER INSURANCE CO.
TXBLUE CROSSOtherBLUE CROSS
TX00N804Medicare ID - Type Unspecified
TX1338246Medicaid