MEDICARE: DAVID C. BRADSHAW, M.D. APC

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	208100000X	Physical Medicine & Rehabilitation Physician	C38599	CA

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	:	1740504927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID C. BRADSHAW, M.D. APC

Provider Business Mailing Address
First Line	:	PO BOX 1460
Second Line	:
City	:	SUISUN CITY
State	:	CA
Zip	:	94585-4460
Country	:	US
Telephone Number	:	510-964-0458
Fax Number	:	510-964-0476

Provider Business Practice Location Address
First Line	:	19830 LAKE CHABOT RD
Second Line	:	SUITE C
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-4063
Country	:	US
Telephone Number	:	510-964-0458
Fax Number	:	510-964-0476

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. DAVID CLIETT BRADSHAW
Credential	:	M.D.
Telephone Number	:	510-964-0458

Provider Enumeration Date	:	03/17/2010
Last Update Date	:	03/17/2010

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