Healthcare Provider Details

I. General information

NPI: 1134153273
Provider Name (Legal Business Name): DAWN BRADFORD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 WALLACE BLVD
AMARILLO TX
79106-1745
US

IV. Provider business mailing address

5707 HAMPTON DR
AMARILLO TX
79109-7141
US

V. Phone/Fax

Practice location:
  • Phone: 806-212-0699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM1531
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: