Healthcare Provider Details

I. General information

NPI: 1932439270
Provider Name (Legal Business Name): JOE DALE BRADSHAW RT,RVT,RDMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2404 YONKERS ST STE 4
PLAINVIEW TX
79072-1820
US

IV. Provider business mailing address

2404 YONKERS ST STE 4
PLAINVIEW TX
79072-1820
US

V. Phone/Fax

Practice location:
  • Phone: 806-293-2735
  • Fax: 806-293-4231
Mailing address:
  • Phone: 806-293-2735
  • Fax: 806-293-4231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number5221
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: