Individual
BRADLEY EDWARD LOUIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2500 N STATE ST # S139-01, JACKSON, MS 39216-4500
(601) 815-8489
(601) 984-2086
Mailing address
2500 N STATE ST # S139-01, JACKSON, MS 39216-4500
(601) 815-8489
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
T-5122
MS
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/05/2023
Last updated
08/21/2023
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