Individual
MR. BRADFORD STEELE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
2500 NORTH STATE STREET, DEPARTMENT OF ORTHOPEDICS, JACKSON, MS 39216-4505
(601) 815-3045
Mailing address
PO BOX 11407 DEPT 2130, STATE OF MS-UNIVERSITY OF MS MEDICAL CENTER, BIRMINGHAM, AL 35246-2130
(601) 984-6426
(601) 984-6439
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R850364
MS
363LF0000X
Family Nurse Practitioner
R850364
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00754004
—
MS
01
—
RR# P00636223
RR#P00636223
—
Enumeration date
10/02/2006
Last updated
04/24/2013
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