Basic Information
| Provider Information | |||||||||
| NPI: | 1306165345 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | BRADFORD | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1303 AZALEA CT | ||||||||
| Address2: | STE C | ||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295775765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436920570 | ||||||||
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| Practice Location | |||||||||
| Address1: | DUKE UNIVERSITY MEDICAL CENTER DEPT OF RADIOLOGY | ||||||||
| Address2: | DIVISION OF NEURORADIOLOGY, BOX 3808 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196847406 | ||||||||
| FaxNumber: | 9196847157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2010 | ||||||||
| LastUpdateDate: | 06/27/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | TL39580 | SC | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.