Provider Demographics
NPI:1952363715
Name:WERRELL, BRADLEY H (DO)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:H
Last Name:WERRELL
Suffix:
Gender:M
Credentials:DO
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 2509
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85502-2509
Mailing Address - Country:US
Mailing Address - Phone:928-425-8151
Mailing Address - Fax:928-425-9425
Practice Address - Street 1:5990 S HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-9462
Practice Address - Country:US
Practice Address - Phone:928-425-8151
Practice Address - Fax:928-425-9425
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4540207Q00000X, 204D00000X
OH34007912207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2404937Medicaid
OH2404937Medicaid
AZZ113309Medicare PIN
OHWE4106012Medicare ID - Type Unspecified