Healthcare Provider Details

I. General information

NPI: 1194740217
Provider Name (Legal Business Name): LETITIA L BRADFORD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 RED ROCK DR
GALLUP NM
87301-5683
US

IV. Provider business mailing address

1901 RED ROCK DR
GALLUP NM
87301-5683
US

V. Phone/Fax

Practice location:
  • Phone: 505-863-7309
  • Fax:
Mailing address:
  • Phone: 505-863-7309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA70194
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberLT-2827
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number14581
License Number StateNH
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD2020-0288
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: