Provider Demographics
NPI:1366641789
Name:DYRSTAD, BRADLEY W (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:W
Last Name:DYRSTAD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 PARKS LEGADO CT
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-2542
Mailing Address - Country:US
Mailing Address - Phone:432-332-2663
Mailing Address - Fax:432-335-8849
Practice Address - Street 1:1 PARKS LEGADO CT
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-2542
Practice Address - Country:US
Practice Address - Phone:432-332-2663
Practice Address - Fax:432-335-8849
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2021-12-09
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Provider Licenses
StateLicense IDTaxonomies
OH35.099289207X00000X
WI60790207X00000X
IL125-052536207X00000X
TXP4440207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery