Healthcare Provider Details

I. General information

NPI: 1629659545
Provider Name (Legal Business Name): BRADLEY JOHN BOGET DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GORDON GUTMANN BLVD STE 401
JEFFERSONVILLE IN
47130-3768
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-0637
  • Fax: 812-283-6630
Mailing address:
  • Phone: 502-975-2219
  • Fax: 502-272-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5151014822
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number06253
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number02008853A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: