Healthcare Provider Details

I. General information

NPI: 1295313690
Provider Name (Legal Business Name): BRADLEY JEREW DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 HIGHWAY 280
BIRMINGHAM AL
35242-5185
US

IV. Provider business mailing address

7045 LIGHTHOUSE WAY
PERRYSBURG OH
43551-7000
US

V. Phone/Fax

Practice location:
  • Phone: 205-408-1231
  • Fax: 205-408-1229
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3789
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: