Healthcare Provider Details

I. General information

NPI: 1639294259
Provider Name (Legal Business Name): DAVID D BRADLEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 32ND AVE S
FARGO ND
58103-6132
US

IV. Provider business mailing address

400 E 3RD ST SSB6
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-8900
  • Fax: 701-364-8078
Mailing address:
  • Phone: 218-786-3146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number14574
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPT14574
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number52167
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: