Provider Demographics
NPI:1316936743
Name:BRADLEY-ROLON MD, VICTOR ENRIQUE (MD INTERNIST)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:ENRIQUE
Last Name:BRADLEY-ROLON MD
Suffix:
Gender:M
Credentials:MD INTERNIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:110 E SAVANNAH AVE BLDG A STE 201
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1230
Mailing Address - Country:US
Mailing Address - Phone:956-631-2175
Mailing Address - Fax:956-631-2175
Practice Address - Street 1:110 E SAVANNAH AVE BLDG A STE 201
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503
Practice Address - Country:US
Practice Address - Phone:956-780-5501
Practice Address - Fax:956-780-5501
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD4721207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034559701Medicaid
TX034559702Medicaid
TX034559702Medicaid
C13690Medicare UPIN