Provider Demographics
NPI:1427065739
Name:LOW, BRADLEY LEE (DO)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:LEE
Last Name:LOW
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:PO BOX 2508
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-2508
Mailing Address - Country:US
Mailing Address - Phone:307-250-6849
Mailing Address - Fax:307-800-3487
Practice Address - Street 1:901 16TH ST
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3802
Practice Address - Country:US
Practice Address - Phone:307-250-6849
Practice Address - Fax:307-800-3487
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYTL#1520207L00000X, 207LP2900X
MO2006018422207L00000X
MT11837207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine