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Individual
DR. BRADLEY KEITH BROYLES
Active
Individual
DR. BRADLEY KEITH BROYLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
39049
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
390491
—
SC
01
—
SC85638510
MEDICARE PIN
SC
01
—
SC85639068
MEDICARE PIN
SC
Enumeration date
04/03/2013
Last updated
12/08/2020
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