Individual
DR. BRADLEY E SAMUELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1004 BROOK AVE, WICHITA FALLS, TX 76301-5007
(940) 687-7100
(940) 687-7104
Mailing address
1004 BROOK AVE, WICHITA FALLS, TX 76301-5007
(940) 687-7100
(940) 687-7104
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
J5005
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022402-04
—
TX
Enumeration date
08/28/2006
Last updated
10/10/2012
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