# DR. BRADLEY WILLIAM NORDYKE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1972560423
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | J7115 | TX | Yes |

## Other

- **Enumeration date:** 04/27/2006
- **Last updated:** 12/06/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1269698-03 | — | TX |
| 05 | — | 1269698-04 | — | TX |
| 01 | — | 126969811 | MEDICAID - MAOB | TX |
| 01 | — | 1F0206 | MEDICARE - MAOB | TX |