Individual
BRADLEY C. HARVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 606-4522
Mailing address
PO BOX 452319, SUNRISE, FL 33345-2319
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
649837
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165123401
—
TX
05
—
165123408
—
TX
01
—
1O6211
MEDICARE
TX
Enumeration date
02/02/2006
Last updated
05/01/2024
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