Individual
DR. BRADLEY P LARGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
975 E 3RD ST, CHATTANOOGA, TN 37403-2103
(423) 266-1490
(423) 778-2108
Mailing address
PO BOX 70, CHATTANOOGA, TN 37401-0070
(423) 778-3274
(423) 778-2255
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
34770
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396719753
NPI
TN
01
—
38650821
WELLCARE
TN
01
—
4160436
BLUE SHIELD
TN
Enumeration date
02/14/2006
Last updated
09/10/2008
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