Individual
BRAD LEE JIMMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
215 STRATTON RD, RUTLAND, VT 05701-4621
(802) 775-7745
(802) 775-5155
Mailing address
215 STRATTON RD, RUTLAND, VT 05701-4621
(802) 775-7745
(802) 775-5155
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
042-0010388
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008803
—
VT
Enumeration date
07/12/2006
Last updated
03/15/2012
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