1174624506 NPI number — DR. GEORGE M BRADFORD D.M.D.

Table of content: DR. GEORGE M BRADFORD D.M.D. (NPI 1174624506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174624506 NPI number — DR. GEORGE M BRADFORD D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADFORD
Provider First Name:
GEORGE
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.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:
1174624506
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5741 CARMICHAEL PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36117-2340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-277-3492
Provider Business Mailing Address Fax Number:
334-277-9432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5741 CARMICHAEL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36117-2340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-277-3492
Provider Business Practice Location Address Fax Number:
334-277-9432
Provider Enumeration Date:
09/26/2006

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: 1223S0112X , with the licence number:  3150 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000090657 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51090657 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51047565 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51005719 . This is a "BCBS AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-05901 . This is a "BC/BC OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51549612 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 650035 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009910120 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009983310 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com