Ryan Bradley, PA-C, CAQ-PSY
Physician Assistant, Medical in Eglin, FL. Individual provider (NPI-1).
NPI number1235862012
StatusActive
Last updated in NPPESOct 4, 2024
Details
- NPI
- 1235862012
- Entity type
- Individual (NPI-1)
- Name
- Mr. Ryan Bradley
- Credential
- PA-C, CAQ-PSY
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 7, 2022
- Certification date
- Oct 4, 2024
- Last updated
- Oct 4, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | 9118992 | FL | Yes |
| 363A00000X | Physician Assistant | 1198847 | TX |
Practice location
4315 El Salvador WayEglin, FL 32542-1711
Phone 575-386-6585
Mailing address
6600 Van Aalst BlvdFort Moore, GA 31905-2102
Phone 915-742-2273
Other practice locations
6600 Van Aalst Blvd
Fort Moore, GA 31905-2102
Fort Moore, GA 31905-2102
Phone 915-742-2273
1 11th Ave Ste A2
Shalimar, FL 32579-1318
Shalimar, FL 32579-1318
Phone 850-790-9621
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