Healthcare Provider Details

I. General information

NPI: 1164459707
Provider Name (Legal Business Name): STEVEN ALLEN BRADSHER IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 NARROWS VIEW LN NE # 202
BREMERTON WA
98310-6605
US

IV. Provider business mailing address

NAVAL UNDERSEA MEDICAL INSTITUTE P.O. BOX 159
GROTON CT
06349-5159
US

V. Phone/Fax

Practice location:
  • Phone: 360-621-4268
  • Fax:
Mailing address:
  • Phone: 360-621-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: