Healthcare Provider Details

I. General information

NPI: 1821318262
Provider Name (Legal Business Name): BRADLEY HUGHES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14780 W MOUNTAIN VIEW BLVD SUITE 110
SURPRISE AZ
85374-7280
US

IV. Provider business mailing address

1750 E BELL ROAD APT 166
PHOENIX AZ
85022
US

V. Phone/Fax

Practice location:
  • Phone: 623-374-7774
  • Fax:
Mailing address:
  • Phone: 602-839-3339
  • Fax: 602-495-9112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46945
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: