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Individual

CHARLES F BRADY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
903 C NORTH 5TH STREET, ESTANCIA, NM 87016
(505) 384-2777
Mailing address
229 NOGAL PL, EL PASO, TX 79915-4516

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
J8928
TX
2083X0100X
Occupational Medicine Physician
J8928
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000E5032
NM
01
00400M
BLUE CROSS BLUE SHIELD OF NEW MEXICO
NM
05
119038103
TX
01
36224
PRESBYTERIAN HEALTH PLAN
NM
01
PROVP11371
MOLINA HEALTHCARE
NM
Enumeration date
10/13/2005
Last updated
06/18/2008
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