Individual
KEVIN BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SOIDC
Contact information
Practice address
903 13TH ST, VIRGINIA BEACH, VA 23451-4476
(910) 465-5610
Mailing address
903 13TH ST, VIRGINIA BEACH, VA 23451-4476
(910) 465-5610
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1367445790
NAVY
—
Enumeration date
07/23/2020
Last updated
07/23/2020
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