Individual
BRENT J BEDKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1740 SYCAMORE AVE STE C, KINGMAN, AZ 86409-1039
(507) 284-2511
Mailing address
1740 SYCAMORE AVE STE C, KINGMAN, AZ 86409-1039
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
48849
AZ
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
52935
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
916106
—
AZ
Enumeration date
07/13/2009
Last updated
03/17/2018
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