Individual
DR. BRADLEY C STUFFLEBAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
629 SABLE DR, CENTRALIA, IL 62801-4472
(618) 533-0727
Mailing address
629 SABLE DR, CENTRALIA, IL 62801-4472
(618) 533-0727
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036-058847
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-058847
STATE LICENSE #
IL
Enumeration date
07/12/2006
Last updated
03/07/2023
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