1841293909 NPI number — DR. ALFRED B. BRADY JR. M.D.

Table of content: DR. ALFRED B. BRADY JR. M.D. (NPI 1841293909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841293909 NPI number — DR. ALFRED B. BRADY JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADY
Provider First Name:
ALFRED
Provider Middle Name:
B.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841293909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
755 N 11TH ST
Provider Second Line Business Mailing Address:
STE P2200
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77702-1500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-892-1192
Provider Business Mailing Address Fax Number:
409-924-9012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
755 N 11TH ST
Provider Second Line Business Practice Location Address:
STE P2200
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77702-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-892-1192
Provider Business Practice Location Address Fax Number:
409-924-9012
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  D3567 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0473832 . This is a "AETNA ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1338246 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 76-0091070 . This is a "OTHER INSURANCE CO." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: BLUE CROSS . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com