MEDICARE: DR. RULON RALPH BRADLEY M.D.

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	207N00000X	Dermatology Physician	1620901205	UT
2	207NS0135X	Procedural Dermatology Physician	1620908905	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0391841	OTHER	UT	UNITED HEALTH CARE/AM
2	0391841	OTHER	UT	UNITED HEALTH CARE/PLUS
3	1424448	OTHER	UT	FIRST HEALTH
4	0300062	OTHER	UT	AARP/UNITED HEALTH CARE
5	0300062	OTHER	UT	UHC EMPLOYEE CLAIMS
6	1181	OTHER	UT	PUBLIC EMPLOYEES HEALTH
7	0300062	OTHER	UT	UNITED HEALTH CARE
8	4116634	OTHER	UT	AETNA
9	0300062	OTHER	UT	UNITED MED CHOICE
10	123482	OTHER	UT	ALTIUS SUMMIT CARE
11	123482	OTHER	UT	ALTIUS

General Provider Information

NPI Number	:	1386681005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RULON RALPH BRADLEY M.D.

Provider Business Mailing Address
First Line	:	4659 STILLWOOD CIR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-8055
Country	:	US
Telephone Number	:	801-278-5902
Fax Number	:

Provider Business Practice Location Address
First Line	:	166 E 5900 S
Second Line	:	SUITE B-111
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-7257
Country	:	US
Telephone Number	:	801-268-9672
Fax Number	:	801-266-9390

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	09/11/2025

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