TIMOTHY M BRADLEY,MD SC (NPI# 1275873275) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275873275 |
| Entity Type | Organization |
| Organization Name | TIMOTHY M BRADLEY,MD SC |
| Practice Address |
1032 Mar Walt Dr Suite 240 Fort Walton Beach FL 32547-6661 |
| Mailing Address |
Po Box 747 Fort Walton Beach FL 32549-0747 |
| Practice Telephone | 8505330865 |
| Practice Fax Number | 8503147005 |
| Mailing Telephone | 6185313199 |
| Enumeration Date | 2013-02-27 |
| Last Update Date | 2013-02-27 |
| Authorized Official Name | DR. TIMOTHY MICHAEL BRADLEY (PRESIDENT) |
| Authorized Official Telephone | 6185313199 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2082S0105X |
Plastic Surgery Specialization: Surgery of the Hand |
ME111099 | FL | Allopathic & Osteopathic Physicians |
| Y | 208200000X | Plastic Surgery | ME111099 | FL | Allopathic & Osteopathic Physicians |
| Street Address |
1032 MAR WALT DR SUITE 240 |
| City | FORT WALTON BEACH |
| State | FL |
| Zip Code | 32547-6661 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609872688 | John Robert Brent | Surgery | 1032 Mar Walt Dr, Ste 220, Fort Walton Beach, FL 32547-6645 | 2005-06-23 |
| 1205175635 | Barnett Facial Plastic & Reconstructive Surgery, Pa. | Otolaryngology | 1032 Mar Walt Dr, Suite 100, Fort Walton Beach, FL 32547-6661 | 2013-02-05 |
| 1790912269 | Northwest Florida Multispecialty Physicians LLC | Neurological Surgery | 1032 Mar Walt Dr, Suite 250, Fort Walton Beach, FL 32547-6661 | 2009-06-11 |
| 1679762611 | John R. Brent Md Pa | Specialist | 1032 Mar Walt Dr, Suite 220, Fort Walton Beach, FL 32547-6661 | 2007-10-16 |
| 1710172416 | Northwest Florida Womens Cancer Care LLC | Obstetrics & Gynecology | 1032 Mar Walt Dr, Suite 250, Fort Walton Beach, FL 32547-6661 | 2007-09-06 |
| 1497823942 | Inna Victorovna Martire | Physician Assistant | 1032 Mar Walt Dr, Fort Walton Beach, FL 32547-6645 | 2006-12-01 |
| 1912928896 | Ft Walton Beach Internal Medicine LLC | Internal Medicine | 1032 Mar Walt Dr, Suite 230, Fort Walton Beach, FL 32547-6645 | 2006-07-23 |
| 1295769263 | Beach Orthopaedic & Sports Medicine Clinic, Pa | Orthopaedic Surgery | 1032 Mar Walt Dr, Suite 210, Fort Walton Beach, FL 32547-6645 | 2006-07-10 |
| 1831122803 | Kenneth Robert Ellison | Physician Assistant | 1032 Mar Walt Dr, Suite 250, Fort Walton Beach, FL 32547-6661 | 2006-07-10 |
| 1265477574 | Emerald Coast Ear, Nose, Throat & Allergies, P.a. | Health Maintenance Organization | 1032 Mar Walt Dr, Suite 100, Fort Walton Beach, FL 32547-6645 | 2006-06-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255944955 | Theresa Ann Morvay | Behavior Technician | 419 Racetrack Rd Ne, Fort Walton Beach, FL 32547 | 2020-08-24 |
| 1588295422 | Emily Ann Glossop | Nurse Practitioner | 930 Mar Walt Drive C, Fort Walton Beach, FL 32547 | 2020-01-29 |
| 1225669443 | Elizabeth Rogers Nagengast | Physician Assistant | 930 Mar Walt Drive, Unit C, Fort Walton Beach, FL 32547 | 2020-01-27 |
| 1497254791 | Carmen Alston | Nurse Practitioner | 930 Mar Walt Dr C, Fort Walton Beach, FL 32547 | 2018-02-02 |
| 1871004960 | Center for Neuropsychological Services Cns | Clinical Neuropsychologist | 1817 Lewis Turner Blvd, Fort Walton Beach, FL 32547 | 2017-10-17 |
| 1194235648 | Robin Wray | Speech-Language Pathologist | 930 Mar Walt Dr D, Fort Walton Beach, FL 32547 | 2017-10-10 |
| 1285007989 | Dynamic Pain & Wellness Pllc | Pain Medicine | 930 Marwalt Drive, Suite B and C, Fort Walton Beach, FL 32547 | 2015-11-04 |
| 1013392810 | Terry Abbott | Social Worker | 648 Overbrook Dr, Fort Walton Beach, FL 32547 | 2015-07-22 |
| 1083024673 | Emily Lohr | Physical Therapy Assistant | 2000 Principle Ln, Ft. Walton Beach, FL 32547 | 2014-05-05 |
| 1831526102 | Laurie Ann Schweppe | Nurse Practitioner | 1005 Mar Walt Drivve, Snf Hospitalist Department, Fort Walton Beach, FL 32547 | 2013-10-02 |
| Find all providers in zip 32547 | ||||
| Taxonomy Code | 208200000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Plastic Surgery |
| A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Plastic Surgery, 2007. http://www.abplsurg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Plastic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962472142 | Christopher Michael Dress | Plastic Surgery | 11 Racetrack Rd Ne, Ste E4, Fort Walton Beach, FL 32547-1867 | 2006-01-23 |
| 1194077099 | Dress Reconstructive Surgery, P.a. | Plastic Surgery | 11 Racetrack Rd Ne, Ste. E4, Fort Walton Beach, FL 32547-1882 | 2012-10-03 |
| 1619282753 | Dress Cosmetic Surgery, P.a. | Plastic Surgery | 11 Racetrack Rd Ne, Ste. E4, Fort Walton Beach, FL 32547-1882 | 2010-08-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275166720 | Ph1 Miami | Plastic Surgery | 8585 Sw 72nd St Ste 107, Miami, FL 33143-3746 | 2020-02-12 |
| 1720619927 | Jhs Surgical Pavillion LLC | Plastic Surgery | 3319 S State Road 7 Ste 107, Wellington, FL 33449-8099 | 2020-01-28 |
| 1861048498 | Alexandra Conde Green Md Pa | Plastic Surgery | 4788 N Citation Dr Apt 105, Delray Beach, FL 33445-6532 | 2019-08-09 |
| 1962062885 | Zunilda Rodriguez Martinez | Plastic Surgery | 7360 Sw 24th St, Miami, FL 33155-1498 | 2019-06-13 |
| 1962960146 | Elite Surgery Center, LLC | Plastic Surgery | 5301 4th Ave Circle E, Bradenton, FL 34208 | 2019-03-07 |
| 1508335985 | Plastic Surgery Associates of Miami | Plastic Surgery | 6541 Sw 76th Ter, South Miami, FL 33143-4656 | 2018-11-15 |
| 1023592177 | Lake Mary Plastic and Cosmetic Surgery Pa | Plastic Surgery | 934 Williston Park Pt Ste 1028, Lake Mary, FL 32746-2165 | 2018-09-24 |
| 1790271096 | Rsm Plastic Surgery, Pa | Plastic Surgery | 3300 W Lake Mary Blvd Ste 210, Lake Mary, FL 32746-3499 | 2018-07-10 |
| 1609306877 | South Beach Plastic Surgery, P.a. | Plastic Surgery | 1820 James Ave Apt 6d, Miami Beach, FL 33139-7462 | 2017-06-19 |
| 1295278943 | Florida Dermatology Plastic Surgery LLC | Plastic Surgery | 6559 N Wickham Rd, Suite 105, Melbourne, FL 32940-2039 | 2016-11-29 |
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| City | FORT WALTON BEACH |
| Zip Code | 32547 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.