Healthcare Provider Details

I. General information

NPI: 1598450660
Provider Name (Legal Business Name): BRADLEY EDWARD LOUIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 9TH AVE SW STE 310
BESSEMER AL
35022-7839
US

IV. Provider business mailing address

405 BELCHER ST
CENTREVILLE AL
35042-2946
US

V. Phone/Fax

Practice location:
  • Phone: 205-277-2358
  • Fax:
Mailing address:
  • Phone: 205-926-2992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO.4795
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: