Provider Demographics
NPI:1174584072
Name:LAIR, BRADLEY L (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:L
Last Name:LAIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1221 PLEASANT
Mailing Address - Street 2:STE 100
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309
Mailing Address - Country:US
Mailing Address - Phone:515-282-2921
Mailing Address - Fax:515-282-1035
Practice Address - Street 1:1221 PLEASANT
Practice Address - Street 2:STE 100 MEDICAL ONCOLOGY AND HEMATOLOGY
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309
Practice Address - Country:US
Practice Address - Phone:515-282-2921
Practice Address - Fax:515-282-1035
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2010-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA31378207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0159764Medicaid
IA58988Medicare ID - Type Unspecified
IA0159764Medicaid