Provider Demographics
NPI:1033283247
Name:HOUSMAN, BRADLEY WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:WAYNE
Last Name:HOUSMAN
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:PO BOX 9685
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9685
Mailing Address - Country:US
Mailing Address - Phone:270-575-4551
Mailing Address - Fax:270-575-4560
Practice Address - Street 1:2603 KENTUCKY AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003
Practice Address - Country:US
Practice Address - Phone:270-575-4551
Practice Address - Fax:270-575-4560
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33501207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000188608OtherBCBS
KY64014103Medicaid
KY0310403Medicare ID - Type Unspecified
H25135Medicare UPIN