Diner, Bradley Canada

Diner, Bradley Canada is an individual health care provider with primary practice located at 4 Executive Center Ct , Little Rock AR 72211-4487. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Diner, Bradley Canada can be contacted via phone (501) 448-0060.

Contact Information

Primary practice address
4 Executive Center Ct Little Rock AR 72211-4487
Phone: (501) 448-0060
Fax: (501) 448-0066
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X C6817 Arkansas

Profile Details

NPI number 1194793398
LBN Legal business name Diner, Bradley Canada
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 14th, 2006
Last updated Mar 18th, 2013 - about 11 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 1194793398 NPPES
Arkansas MEDICAID 117612001
Arkansas Other 53985

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