Provider Demographics
NPI:1174901581
Name:GARDEN, BRADLEY M (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:M
Last Name:GARDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5850 CORAL RIDGE DR
Mailing Address - Street 2:STE 106
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3379
Mailing Address - Country:US
Mailing Address - Phone:954-714-8200
Mailing Address - Fax:954-840-2626
Practice Address - Street 1:5850 CORAL RIDGE DR STE 106
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3379
Practice Address - Country:US
Practice Address - Phone:954-714-8200
Practice Address - Fax:954-840-2626
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301107046390200000X
NY390200000X
FLME144394208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty