Individual
DR. BRADLEY PAETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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