Individual
DR. RANDALL L BRADDOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1093 GOLDEN GROVE DR, THE VILLAGES, FL 32162-4023
(908) 601-7036
(352) 561-4512
Mailing address
1093 GOLDEN GROVE DR, THE VILLAGES, FL 32162-4023
(908) 601-7036
(352) 561-4512
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
25MA02637400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9074201
—
NJ
Enumeration date
01/27/2006
Last updated
06/03/2013
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