Individual
DR. BRADLEY KENNETH DEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13 MAIN ST., SAN QUENTIN PRISON, SAN QUENTIN, CA 94964
(415) 454-1460
Mailing address
13 MAIN STREET, SAN QUENTIN PRISON, SAN QUENTIN, CA 94964
(415) 454-1460
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
A102530
CA
2084P0800X
Psychiatry Physician
ME94046
FL
2084P0804X
Child & Adolescent Psychiatry Physician
A102530
CA
2084P0804X
Child & Adolescent Psychiatry Physician
ME94046
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276684100
—
FL
Enumeration date
11/05/2005
Last updated
03/15/2012
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