Provider Demographics
NPI:1780935916
Name:BRADER, BRIAN (AP, DOM)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:BRADER
Suffix:
Gender:M
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 36TH ST W
Mailing Address - Street 2:SUITE D
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-2459
Mailing Address - Country:US
Mailing Address - Phone:941-745-1313
Mailing Address - Fax:941-745-1334
Practice Address - Street 1:515 36TH ST W
Practice Address - Street 2:SUITE D
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-2459
Practice Address - Country:US
Practice Address - Phone:941-745-1313
Practice Address - Fax:941-745-1334
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2653171100000X
WI661-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist