Provider Demographics
NPI:1861754590
Name:KEITH BRADY, M.D., P.A
Entity type:Organization
Organization Name:KEITH BRADY, M.D., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-820-7992
Mailing Address - Street 1:1201 5TH AVE N
Mailing Address - Street 2:SUITE 412
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1400
Mailing Address - Country:US
Mailing Address - Phone:727-820-7992
Mailing Address - Fax:727-820-7901
Practice Address - Street 1:1201 5TH AVE N
Practice Address - Street 2:SUITE 412
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1400
Practice Address - Country:US
Practice Address - Phone:727-820-7992
Practice Address - Fax:727-820-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37799261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care