Goettl, Bradley Tait

Goettl, Bradley Tait is an individual health care provider with primary practice located at 4502 Medical Dr , San Antonio TX 78229-4402. He recently has 3 registered licenses in different health care specialties including Emergency Medical Service Providers / Emergency Medical Technician, Paramedic, Nursing Service Providers / Emergency, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is his primary health care specialty. Goettl, Bradley Tait can be contacted via phone (210) 358-2078.

Contact Information

Primary practice address
4502 Medical Dr San Antonio TX 78229-4402
Phone: (210) 358-2078
Fax: (210) 358-1972
Website:
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Health care specialties

SpecialtyCodeLicense #State
Emergency Medical Service Providers / Emergency Medical Technician, Paramedic 146L00000X 709205 Texas
Nursing Service Providers / Emergency 163WE0003X 766200 Texas
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X AP125858 Texas
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 6653-33 Wisconsin

Profile Details

NPI number 1740694454
LBN Legal business name Goettl, Bradley Tait
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 20th, 2014
Last updated Sep 27th, 2016 - about 8 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 1740694454 NPPES
Texas MEDICAID 339105407
Texas Other 339105408

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