Healthcare Provider Details

I. General information

NPI: 1386601540
Provider Name (Legal Business Name): JOHN C BRADFORD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WABASH AVE
AKRON OH
44307
US

IV. Provider business mailing address

21755 BROOKPARK ROAD
CLEVELAND OH
44126
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-1799
  • Fax: 330-253-8293
Mailing address:
  • Phone: 440-777-6300
  • Fax: 440-777-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34002912
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: