Healthcare Provider Details

I. General information

NPI: 1396748877
Provider Name (Legal Business Name): WILLIAM B BRADFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 N JACKSON ST
TULLAHOMA TN
37388-2208
US

IV. Provider business mailing address

DEPT 0765 PO BOX 11407
BIRMINGHAM AL
35246-0765
US

V. Phone/Fax

Practice location:
  • Phone: 931-454-9423
  • Fax: 931-454-9690
Mailing address:
  • Phone: 256-383-3325
  • Fax: 480-212-8451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD0000025802
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: