Individual
WILLIAM BRAD SPEAKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
220 BANNOCK ST, MALAD CITY, ID 83252-5068
(208) 766-2600
(208) 766-4258
Mailing address
220 BANNOCK ST, MALAD CITY, ID 83252-5068
(208) 766-2600
(208) 766-4258
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-240
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805780000
—
ID
Enumeration date
06/21/2006
Last updated
06/09/2022
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