Individual
BRADY JAY COBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153
(708) 327-3041
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 327-3041
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
125.072863
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
IL
Other
Enumeration date
03/20/2018
Last updated
06/06/2018
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