Brobeck, Bradley R

Brobeck, Bradley R is an individual health care provider with primary practice located at 1000 Mar Walt Dr , Fort Walton Beach FL 32547-6708. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Brobeck, Bradley R can be contacted via phone (850) 315-7807.

Contact Information

Primary practice address
1000 Mar Walt Dr Fort Walton Beach FL 32547-6708
Phone: (850) 315-7807
Fax: (850) 863-7579
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 220353 Massachusetts
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 00027338 Alabama
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X ME95580 Florida

Profile Details

NPI number 1891772356
LBN Legal business name Brobeck, Bradley R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 27th, 2005
Last updated Nov 12th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891772356 NPPES
Massachusetts Other J27261 BCBS MA
Massachusetts MEDICAID 2060671 BCBS MA
Massachusetts Other 469114 BCBS MA
Massachusetts MEDICAID 106713 BCBS MA
Massachusetts MEDICAID 106712 BCBS MA
Massachusetts MEDICAID 108488 BCBS MA
Massachusetts MEDICAID 275424000 BCBS MA
Massachusetts MEDICAID 009939598 BCBS MA
Massachusetts MEDICAID 108076 BCBS MA

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