MEDICARE: MR. LAMON BRADFORD

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1548002579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAMON BRADFORD

Provider Business Mailing Address
First Line	:	622 WEST IH 10
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-4611
Country	:	US
Telephone Number	:	210-447-0028
Fax Number	:

Provider Business Practice Location Address
First Line	:	2024 SUN COUNTRY DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79938-4611
Country	:	US
Telephone Number	:	915-345-8305
Fax Number	:

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

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	06/20/2024

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Directions to “ MR. LAMON BRADFORD ” Practice Location

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