Basic Information
| Provider Information | |||||||||
| NPI: | 1508872458 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRADY | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 996 | ||||||||
| Address2: | |||||||||
| City: | HAYDEN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838350996 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086644026 | ||||||||
| FaxNumber: | 2086644840 | ||||||||
| Practice Location | |||||||||
| Address1: | 3911 CASTLEVALE ROAD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989027807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094549499 | ||||||||
| FaxNumber: | 5094574994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 05/13/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | MD00044836 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 8421083 | 05 | WA | MEDICAID | 8421803 | 05 | WA | MEDICAID |