Healthcare Provider Details

I. General information

NPI: 1437530896
Provider Name (Legal Business Name): BRADLEY CARL SEVY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 JENKINS MEMORIAL RD
WELLSTON OH
45692-9561
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1562
US

V. Phone/Fax

Practice location:
  • Phone: 740-384-2167
  • Fax: 740-446-5073
Mailing address:
  • Phone: 740-446-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.013506
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: