Individual
ROBERT WAYNE BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYCHOLOGIST
Contact information
Practice address
2692 W WALNUT ST, SUITE 105, GARLAND, TX 75042-6474
(972) 494-2676
Mailing address
2692 W WALNUT ST, SUITE 105, GARLAND, TX 75042-6474
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
22628
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
097798502
—
TX
Enumeration date
08/22/2005
Last updated
07/12/2007
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