Provider Demographics
NPI:1366984122
Name:TED H. BRADY,D.O.,PA
Entity type:Organization
Organization Name:TED H. BRADY,D.O.,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-721-3008
Mailing Address - Street 1:7710 NW 71ST CT
Mailing Address - Street 2:STE 203
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2973
Mailing Address - Country:US
Mailing Address - Phone:954-721-3008
Mailing Address - Fax:954-721-3088
Practice Address - Street 1:7710 NW 71ST CT
Practice Address - Street 2:STE 203
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2973
Practice Address - Country:US
Practice Address - Phone:954-721-3008
Practice Address - Fax:954-721-3088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5247207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370532300Medicaid