Basic Information
Provider Information
NPI: 1003015157
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COMMONS
FirstName: BRADFORD
MiddleName: STAGER
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5201 HARRY HINES BLVD
Address2: HOUSE STAFF & GME
City: DALLAS
State: TX
PostalCode: 752357708
CountryCode: US
TelephoneNumber: 2145908058
FaxNumber:  
Practice Location
Address1: 5201 HARRY HINES BLVD
Address2: HOUSE STAFF & GME
City: DALLAS
State: TX
PostalCode: 752357708
CountryCode: US
TelephoneNumber: 2145908058
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/17/2007
LastUpdateDate: 05/03/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XN6229TXY Allopathic & Osteopathic PhysiciansEmergency Medicine 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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