Provider Demographics
NPI:1598337636
Name:ANDERSON, BRADY DANIEL (DPM)
Entity type:Individual
Prefix:DR
First Name:BRADY
Middle Name:DANIEL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9301 PARKWEST BLVD.
Mailing Address - Street 2:SUITE A2
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923
Mailing Address - Country:US
Mailing Address - Phone:865-523-5655
Mailing Address - Fax:
Practice Address - Street 1:9330 PARK WEST BLVD STE 300
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4311
Practice Address - Country:US
Practice Address - Phone:865-523-5655
Practice Address - Fax:865-851-9884
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM952213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery