MEDICARE: DR. CHRIS D BRADSHAW D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	5189	OK
2	207P00000X	Emergency Medicine Physician	5189	OK

General Provider Information

NPI Number	:	1255686697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRIS D BRADSHAW D.O.

Provider Business Mailing Address
First Line	:	12610 BLANTON VIEW AVE
Second Line	:
City	:	WAYNE
State	:	OK
Zip	:	73095-3139
Country	:	US
Telephone Number	:	405-443-0211
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 SW 44TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119-2899
Country	:	US
Telephone Number	:	405-388-1818
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2012
Last Update Date	:	03/09/2026

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