Healthcare Provider Details

I. General information

NPI: 1265793640
Provider Name (Legal Business Name): BRADLEY B ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2012
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E MCDOWELL RD LL2
PHOENIX AZ
85006-2612
US

IV. Provider business mailing address

PO BOX 41150
MESA AZ
85274-1150
US

V. Phone/Fax

Practice location:
  • Phone: 602-839-2296
  • Fax: 602-839-2084
Mailing address:
  • Phone: 480-425-2160
  • Fax: 480-351-8797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number52638
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR73368
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: