Healthcare Provider Details

I. General information

NPI: 1306263728
Provider Name (Legal Business Name): DEREK DAVID BRADLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 ZEAMER AVE
JBER AK
99506-3702
US

IV. Provider business mailing address

1201 N MULDOON RD
ANCHORAGE AK
99504-6104
US

V. Phone/Fax

Practice location:
  • Phone: 907-580-7246
  • Fax:
Mailing address:
  • Phone: 907-257-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number181765
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: