Individual
BRADLEY GLEN DOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4920 S 30TH ST STE 103, OMAHA, NE 68107-1656
(402) 734-4110
(402) 734-3990
Mailing address
4920 S 30TH ST STE 103, OMAHA, NE 68107-1656
(402) 734-4110
(402) 734-3990
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC0942
ND
363AM0700X
Medical Physician Assistant
2172
NE
Other
Enumeration date
10/02/2017
Last updated
05/02/2022
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