Healthcare Provider Details

I. General information

NPI: 1629185129
Provider Name (Legal Business Name): BRADLEY SETH ABRAHAMSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 S COLLEGE AVE
FORT COLLINS CO
80525
US

IV. Provider business mailing address

2020 S COLLEGE AVE UNIT C
FORT COLLINS CO
80525-1464
US

V. Phone/Fax

Practice location:
  • Phone: 970-488-1668
  • Fax:
Mailing address:
  • Phone: 970-691-3847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number41009
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: