Healthcare Provider Details

I. General information

NPI: 1669636031
Provider Name (Legal Business Name): TODD WESLEY BRADSHAW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S COULTER ST
AMARILLO TX
79106-1836
US

IV. Provider business mailing address

1100 S COULTER ST
AMARILLO TX
79106-1836
US

V. Phone/Fax

Practice location:
  • Phone: 806-468-9700
  • Fax: 806-468-9771
Mailing address:
  • Phone: 806-468-9700
  • Fax: 806-468-9771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberN8617
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberN8617
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: