Healthcare Provider Details

I. General information

NPI: 1760065130
Provider Name (Legal Business Name): BRADLEY JOSEPH MCCANN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 ZEAMER AVE
ELMENDORF AFB AK
99506-3702
US

IV. Provider business mailing address

PO BOX 428
ENTERPRISE UT
84725-0428
US

V. Phone/Fax

Practice location:
  • Phone: 907-580-2778
  • Fax:
Mailing address:
  • Phone: 801-787-6316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2837
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: