MEDICARE: HAL BRADFORD MD PA

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	174400000X	Specialist	C-7898	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265767859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAL BRADFORD MD PA

Provider Business Mailing Address
First Line	:	3000 N MARKET AVE
Second Line	:	SUITE E
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-3507
Country	:	US
Telephone Number	:	479-444-1440
Fax Number	:	479-444-1447

Provider Business Practice Location Address
First Line	:	3000 N MARKET AVE.
Second Line	:	SUITE E
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-3507
Country	:	US
Telephone Number	:	479-444-1440
Fax Number	:	479-444-1447

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THOMAS HAL BRADFORD
Credential	:	M.D.
Telephone Number	:	479-444-1440

Provider Enumeration Date	:	10/15/2009
Last Update Date	:	03/12/2012

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Directions to “HAL BRADFORD MD PA ” Practice Location

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