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Individual
BRADLEY ROY NOON
Active
Individual
BRADLEY ROY NOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
202D00000X
Integrative Medicine Physician
A78661
CA
207Q00000X
Family Medicine Physician
Primary
A78661
CA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
H62948
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000962794A
—
GA
01
—
017732
BLUE CROSS BLUE SHIELD
GA
Enumeration date
07/18/2006
Last updated
01/30/2025
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