Healthcare Provider Details

I. General information

NPI: 1821271255
Provider Name (Legal Business Name): JOHN K. BRADWAY, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10213 N 92ND ST SUITE 101
SCOTTSDALE AZ
85258-4561
US

IV. Provider business mailing address

10213 N 92ND ST SUITE 101
SCOTTSDALE AZ
85258-4561
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-6005
  • Fax: 480-860-1882
Mailing address:
  • Phone: 480-860-6005
  • Fax: 480-860-1882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number17615
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2150
License Number StateAZ

VIII. Authorized Official

Name: DR. JOHN K. BRADWAY
Title or Position: OWNER
Credential: MD
Phone: 480-860-6005