Organization
ESA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY EAMES D.O. (OWNER)
(254) 694-5092
Entity
Organization
Contact information
Practice address
508 WOODSTREAM PL, MESQUITE, TX 75149-5874
(254) 694-5092
(254) 694-7039
Mailing address
PO BOX 1108, LANCASTER, TX 75146-8108
(254) 694-5092
(254) 694-7039
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
080347001
—
TX
Enumeration date
03/12/2007
Last updated
07/14/2010
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