Timothy M Bradley,MD SC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

ME111099 Issued in FL

Legal business name

TIMOTHY M BRADLEY,MD SC

Practice address

1032 Mar Walt Dr
Suite 240
Fort Walton Beach, FL 32547-6661

Phone

(850) 533-0865

Fax

(850) 314-7005

NPI assigned

Feb 27, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Timothy Michael Bradley, MD

Title

President

Phone

(618) 531-3199

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1361923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361923200000",
    "number": "1275873275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 747",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325490747",
            "telephone_number": "618-531-3199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1032 MAR WALT DR",
            "address_2": "SUITE 240",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476661",
            "telephone_number": "850-533-0865",
            "fax_number": "850-314-7005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY M BRADLEY,MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-27",
        "last_updated": "2013-02-27",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-531-3199",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": "FL",
            "license": "ME111099",
            "primary": true
        },
        {
            "code": "2082S0105X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery, Surgery of the Hand",
            "state": "FL",
            "license": "ME111099",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.