Healthcare Provider Details

I. General information

NPI: 1861652893
Provider Name (Legal Business Name): NATHAN BRADLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST. STE. 5F
OKLAHOMA CITY OK
73104
US

IV. Provider business mailing address

920 STANTON L. YOUNG BLVD. WP2140
OKLAHOMA CITY OK
73104
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-8156
  • Fax: 405-271-6219
Mailing address:
  • Phone: 405-271-6900
  • Fax: 405-271-3118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number26313
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: