Individual
BRADLEY C BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01027732A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000042712
ANTHEM
—
05
—
100116130
—
IN
01
—
1051940
PASSPORT
KY
01
—
245535P
SIHO
—
01
—
33654
IHN
—
01
—
351995025
HUMANA
—
01
—
4114033
FIRST HEALTH
—
01
—
64755762
UNISYS
KY
01
—
690178
FIRST HEALTH
—
01
—
918528
BLOCK VISION
—
Enumeration date
06/21/2005
Last updated
05/12/2008
Update your record
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