Basic Information
| Provider Information | |||||||||
| NPI: | 1396234373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALDONADO | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | BRADLEY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 432 | ||||||||
| Address2: | |||||||||
| City: | PIKEVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415020432 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6900 NW 9TH BLVD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523336680 | ||||||||
| FaxNumber: | 3523314006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2018 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | KY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | OS17967 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.