Individual
BRADLEY A STALTER
Active
Individual
BRADLEY A STALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01057547A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200471880
—
IN
01
—
264430C46
MEDICARE PTAN
IN
01
—
Q00163581
RAILROAD PTAN
IN
Enumeration date
10/26/2005
Last updated
11/28/2023
Update your record
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