MEDICARE: DR. WESLEY G. BRADFORD MD

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	207Q00000X	Family Medicine Physician	G-30342	CA

General Provider Information

NPI Number	:	1821095654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WESLEY G. BRADFORD MD

Provider Business Mailing Address
First Line	:	5122 OCONTO AVE
Second Line	:
City	:	RANCHO PALOS VERDES
State	:	CA
Zip	:	90275-3733
Country	:	US
Telephone Number	:	310-541-6686
Fax Number	:

Provider Business Practice Location Address
First Line	:	5122 OCONTO AVE
Second Line	:
City	:	RANCHO PALOS VERDES
State	:	CA
Zip	:	90275-3733
Country	:	US
Telephone Number	:	310-541-6686
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	10/19/2010

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