Secrest, Bradley N

Secrest, Bradley N is an individual health care provider with primary practice located at 415 S 28Th Ave , Hattiesburg MS 39401-7246. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Secrest, Bradley N can be contacted via phone (601) 268-5888.

Contact Information

Primary practice address
415 S 28Th Ave Hattiesburg MS 39401-7246
Phone: (601) 268-5888
Fax: (601) 261-3587
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X 11852 Mississippi

Profile Details

NPI number 1306955950
LBN Legal business name Secrest, Bradley N
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 29th, 2006
Last updated Aug 7th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306955950 NPPES
Mississippi MEDICAID 00118408
Mississippi Other 64050757297

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