Provider Demographics
NPI:1053622548
Name:NEUMAN, BRADLEY ELEAZAR (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ELEAZAR
Last Name:NEUMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6553 E BAYWOOD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1753
Mailing Address - Country:US
Mailing Address - Phone:480-321-4155
Mailing Address - Fax:
Practice Address - Street 1:6553 E BAYWOOD AVE STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1753
Practice Address - Country:US
Practice Address - Phone:480-321-4155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036169150208600000X
AZR72245208600000X
AZ54062208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery