Provider Demographics
NPI:1982963062
Name:TERRY, BRADFORD WILLIAM
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:WILLIAM
Last Name:TERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 DUNLAVY ST APT 251
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5297
Mailing Address - Country:US
Mailing Address - Phone:214-535-1623
Mailing Address - Fax:
Practice Address - Street 1:4310 DUNLAVY ST APT 251
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5297
Practice Address - Country:US
Practice Address - Phone:214-535-1623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program