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DR. ELOISE DANIEL BRADHAM M.D
>> Specialist >> Other Service ProvidersRegistrant NPI Number: 1194767905
Individual Registrant:DR. ELOISE DANIEL BRADHAM M.D
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
3109 ION AVE SULLIVANS ISLAND, SC 29482-8606 US
Tel: 843-870-7518 Fax: --
Tel: 843-870-7518 Fax: --
Contact information for business:
PO BOX 126 SULLIVANS ISLAND, SC 29482-0126 US
Tel: 843-870-7518 Fax: --
Tel: 843-870-7518 Fax: --
Registration Information:
NPI: 1194767905
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 174400000X | Other Service Providers Specialist | SC | 13644 |
| Y | 207L00000X | Allopathic & Osteopathic Physicians Anesthesiology | SC | 13644 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
