BRAD E. MCCOLLOM, DO
Medical Practice at Bay St, Sebastian, FL

License number
Florida OS9270
Category
Medical Practice
Type
Neurological Surgery
Address
Address
8005 Bay St STE 5, Sebastian, FL 32958
Phone
(772) 581-8075
(772) 581-8031 (Fax)
National Provider ID: 1548264385
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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Brad E Mccollom, DO

8005 Bay St, Sebastian, FL 32958

Industry:
Neurosurgeon
Phone:
(772) 581-8075 (Phone)

BRAD E. MCCOLLOM, D.O., PA

1327 N Central Ave, Sebastian, FL 32958

Status:
Inactive
Industry:
Osteopathic Physician's Office
Inactive reason:
Admin Dissolution For Annual Report
Registration:
Jun 23, 2004
Inactive since:
Sep 25, 2009
State ID:
P04000095908
Business type:
Florida Profit Corporation
President, Treasurer, Director, Secretary:
Brad Ed.o. Mccollom President, Treasurer, Director, Secretary, inactive, 1327 N Central Ave, Sebastian, FL 32958 (Physical)
Agent:
Rene Vandevoorde,1327 N Central Ave, Sebastian, FL 32958 (Physical)
EIN:
N/A

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