Provider Demographics
NPI:1427553973
Name:PANSING, BRADLEY (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:PANSING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRAD
Other - Middle Name:
Other - Last Name:PANSING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2320 RUSK CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3661
Mailing Address - Country:US
Mailing Address - Phone:251-377-1634
Mailing Address - Fax:
Practice Address - Street 1:1034 N 500 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3380
Practice Address - Country:US
Practice Address - Phone:801-357-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14221152-12052086S0129X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery