Organization
BRAD E MCCOLLOM DO PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRAD E MCCOLLOM DO (PRESIDENT)
(772) 581-8075
Entity
Organization
Contact information
Practice address
7764 BAY STREET, SEBASTIAN, FL 32958
(772) 581-8075
(772) 581-8097
Mailing address
787 37TH ST, SUITE E220, VERO BEACH, FL 32960-7305
(772) 581-8075
(772) 581-8097
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
OS9270
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K6779
MEDICARE GROUP
FL
Enumeration date
12/20/2007
Last updated
03/07/2008
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