Individual
DR. BRADLEY PAETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2809 DENNY AVE, PASCAGOULA, MS 39581-5301
(228) 809-5510
(228) 809-5519
Mailing address
2809 DENNY AVE, PASCAGOULA, MS 39581-5301
(228) 809-5510
(228) 809-5519
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16398
MS
208000000X
Pediatrics Physician
16398
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00121267
—
MS
01
—
009917135
ALABAMA MEDICAID AT SRH
—
01
—
110001225
MEDICARE
MS
01
—
110191461
MEDICARE RAILROAD
—
01
—
646000515E
BLUE CROSS OF MS
—
Enumeration date
01/15/2007
Last updated
06/10/2016
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