Provider Demographics
NPI:1376683599
Name:BOBBITT, D. BRADLEY (MD,)
Entity type:Individual
Prefix:DR
First Name:D. BRADLEY
Middle Name:
Last Name:BOBBITT
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8087 WASHINGTON VILLAGE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WASHINGTON TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1840
Mailing Address - Country:US
Mailing Address - Phone:937-432-9669
Mailing Address - Fax:937-432-9694
Practice Address - Street 1:8087 WASHINGTON VILLAGE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:WASHINGTON TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45458-1840
Practice Address - Country:US
Practice Address - Phone:937-432-9669
Practice Address - Fax:937-432-9694
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-9259-B207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2373631Medicaid
OH2006993Medicaid
OHF01453Medicare UPIN