Individual
BRADLEY J WALLRATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5430 MILITARY TRL STE 64, JUPITER, FL 33458-2873
(561) 263-7010
Mailing address
PO BOX 9218, JUPITER, FL 33468-9218
(561) 263-7270
(561) 263-7260
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9107050
FL
363AS0400X
Surgical Physician Assistant
PA9107050
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003134530A
—
GA
05
—
008416700
—
FL
Enumeration date
03/06/2013
Last updated
03/22/2024
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