Healthcare Provider Details

I. General information

NPI: 1245604768
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL BRADSHAW PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 E SOUTHERN AVE STE D
TEMPE AZ
85282-7511
US

IV. Provider business mailing address

2034 E SOUTHERN AVE STE D
TEMPE AZ
85282-7511
US

V. Phone/Fax

Practice location:
  • Phone: 480-923-6200
  • Fax: 602-419-3101
Mailing address:
  • Phone: 480-923-6200
  • Fax: 602-419-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number6128
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6128
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: