Provider Demographics
NPI:1184798704
Name:BRADBURY, WILLIAM B (DPM)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:BRADBURY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 BELLAIRE BLVD
Mailing Address - Street 2:STE GG
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1170
Mailing Address - Country:US
Mailing Address - Phone:713-790-0661
Mailing Address - Fax:713-668-4253
Practice Address - Street 1:4009 BELLAIRE BLVD
Practice Address - Street 2:STE GG
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1170
Practice Address - Country:US
Practice Address - Phone:713-790-0661
Practice Address - Fax:713-668-4253
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX0549213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T12324Medicare UPIN
TX00BK24Medicare ID - Type Unspecified