Provider Demographics
NPI:1386644391
Name:JOST, BRADLEY (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:JOST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 671541
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-1541
Mailing Address - Country:US
Mailing Address - Phone:214-361-6700
Mailing Address - Fax:214-361-6701
Practice Address - Street 1:10740 N CENTRAL EXPY
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2162
Practice Address - Country:US
Practice Address - Phone:214-361-6700
Practice Address - Fax:214-361-6701
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF6807207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology