Individual
DR. BRADLEY WILLIAM SAMUEL
Active
Individual
DR. BRADLEY WILLIAM SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
738
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09702784
—
CO
05
—
955627
—
AZ
01
—
NM01JB06
BLUE SHIELD
NM
Enumeration date
07/07/2006
Last updated
05/22/2012
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