Provider Demographics
NPI:1154382513
Name:BRADY, JOHN (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BRADY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 US HIGHWAY 18 E
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-2162
Mailing Address - Country:US
Mailing Address - Phone:641-357-1999
Mailing Address - Fax:641-357-1997
Practice Address - Street 1:1801 US HIGHWAY 18 E
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-2162
Practice Address - Country:US
Practice Address - Phone:641-357-1999
Practice Address - Fax:641-357-1997
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02940207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1154382513OtherWELLMARK
IA080179260OtherRAILROAD MEDICARE NUMBER
IA1154382513Medicaid
IA509310029Medicare PIN
IA1154382513OtherWELLMARK