Healthcare Provider Details

I. General information

NPI: 1972501401
Provider Name (Legal Business Name): BRADLEY JOHN BRADFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 SE 5TH AVE
DELRAY BEACH FL
33483-5206
US

IV. Provider business mailing address

285 SE 5TH AVE
DELRAY BEACH FL
33483-5206
US

V. Phone/Fax

Practice location:
  • Phone: 561-272-8991
  • Fax: 561-272-8985
Mailing address:
  • Phone: 561-272-8991
  • Fax: 561-272-8985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME80414
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: