Healthcare Provider Details

I. General information

NPI: 1881135804
Provider Name (Legal Business Name): GREGORY J BRADLEY D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S GARNETT RD STE 112
TULSA OK
74146-5201
US

IV. Provider business mailing address

4500 S GARNETT RD STE 112
TULSA OK
74146-5201
US

V. Phone/Fax

Practice location:
  • Phone: 918-935-3550
  • Fax:
Mailing address:
  • Phone: 918-935-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number6368
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number77075
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number6368
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: