Individual
BRADLEY TAIT GOETTL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 358-2078
(210) 358-1972
Mailing address
7703 FLOYD CURL DR, SAN ANTONIO, TX 78229-3901
(210) 358-2078
Taxonomy
Speciality
Code
Description
License number
State
146L00000X
Paramedic
709205
TX
163WE0003X
Emergency Registered Nurse
766200
TX
363LF0000X
Family Nurse Practitioner
6653-33
WI
363LF0000X
Family Nurse Practitioner
Primary
AP125858
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
339105407
—
TX
01
—
339105408
CSHCN
TX
Enumeration date
06/20/2014
Last updated
09/27/2016
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