Healthcare Provider Details

I. General information

NPI: 1669844080
Provider Name (Legal Business Name): BRADLEY ROSS JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2015
Last Update Date: 10/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 N 300 E
CEDAR CITY UT
84720-2620
US

IV. Provider business mailing address

33 N 300 E
CEDAR CITY UT
84720-2620
US

V. Phone/Fax

Practice location:
  • Phone: 435-586-6654
  • Fax: 435-586-6854
Mailing address:
  • Phone: 435-586-6654
  • Fax: 435-586-6854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: