Healthcare Provider Details

I. General information

NPI: 1235556382
Provider Name (Legal Business Name): BRADLEY HUNTER MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8TH AVE AND C STREET
SALT LAKE CITY UT
84143-0001
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-408-1819
  • Fax: 801-408-8453
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number11163289-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: