Provider Demographics
NPI:1548485832
Name:TYM, BRADLEY DENE (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:DENE
Last Name:TYM
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 1:121 RALEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-8347
Mailing Address - Country:US
Mailing Address - Phone:530-230-2000
Mailing Address - Fax:
Practice Address - Street 1:121 RALEY BLVD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-8347
Practice Address - Country:US
Practice Address - Phone:530-230-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79370207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00119086Medicare PIN
CAG29348Medicare UPIN
CA00G793701Medicare ID - Type Unspecified
CA00G793701Medicare PIN