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Organization

TIMOTHY M BRADLEY,MD SC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. TIMOTHY MICHAEL BRADLEY MD (PRESIDENT)
(618) 531-3199
Entity
Organization

Contact information

Practice address
1032 MAR WALT DR, SUITE 240, FORT WALTON BEACH, FL 32547-6661
(850) 533-0865
(850) 314-7005
Mailing address
PO BOX 747, FORT WALTON BEACH, FL 32549-0747
(618) 531-3199

Taxonomy

Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
ME111099
FL
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
ME111099
FL

Other

Enumeration date
02/27/2013
Last updated
02/27/2013
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