Organization
B C STUFFLEBAM, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY CHRISTIAN STUFFLEBAM M.D. (MANAGER)
(618) 533-0727
Entity
Organization
Contact information
Practice address
629 SABLE DR, CENTRALIA, IL 62801-4472
(618) 533-0727
(618) 533-1464
Mailing address
629 SABLE DR, CENTRALIA, IL 62801-4472
(618) 533-0727
(618) 533-1464
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036058847
IL
Other
Enumeration date
04/10/2009
Last updated
04/10/2009
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