Basic Information
| Provider Information | |||||||||
| NPI: | 1295783967 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRADENTON NEUROLOGY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9349 | ||||||||
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| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342069349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417463115 | ||||||||
| FaxNumber: | 9417463201 | ||||||||
| Practice Location | |||||||||
| Address1: | 3930 8TH AVE W | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342051702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417463115 | ||||||||
| FaxNumber: | 9417463201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 12/18/2007 | ||||||||
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| AuthorizedOfficialLastName: | MCELVEEN | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | ALVIN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9417463115 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.