Provider Demographics
NPI:1285528927
Name:BRAGG, FREDRICK ALLEN JR
Entity type:Individual
Prefix:MR
First Name:FREDRICK
Middle Name:ALLEN
Last Name:BRAGG
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7940 W VERDE WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-5200
Mailing Address - Country:US
Mailing Address - Phone:702-683-0212
Mailing Address - Fax:702-683-0212
Practice Address - Street 1:9811 W CHARLESTON BLVD # 2641
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7528
Practice Address - Country:US
Practice Address - Phone:702-683-0212
Practice Address - Fax:702-683-0212
Is Sole Proprietor?:No
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic