Provider Demographics
NPI:1891705794
Name:BRADY, CHAD (DPM)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:BRADY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 JUAN TABO BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2672
Mailing Address - Country:US
Mailing Address - Phone:505-880-1000
Mailing Address - Fax:505-880-1002
Practice Address - Street 1:5111 JUAN TABO BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2672
Practice Address - Country:US
Practice Address - Phone:505-880-1000
Practice Address - Fax:505-880-1002
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM289213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM181866400OtherESA
NMNM005490OtherBLUES
NM201042850OtherPRESBITERIAN
NM10004402OtherLOVELACE
NM4583990001OtherDME
P00078790OtherRAILROAD MCR
NM536064075OtherAETNA
NMPROVB11359OtherMOLINA
NM181866400OtherESA
NMPROVB11359OtherMOLINA