Healthcare Provider Details

I. General information

NPI: 1205253135
Provider Name (Legal Business Name): BRADLEY RYAN JONES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE 222WP2
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE 222WP2
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2700
  • Fax:
Mailing address:
  • Phone: 802-847-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number279014
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number042.0014274
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number279014
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: