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General NPI Number Information
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NPI Number | 1073677977
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Entity Type | Individual
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Provider Name | JASON THOMAS BRADLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 4321 MARSHA SHARP FWY
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City | LUBBOCK
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State | TX
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Zip | 79407-2504
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Country | US
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Telephone | 806-686-3500
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Fax | 806-701-4973
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Provider Business Mailing Address
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Address Line | 4324 23RD ST
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City | LUBBOCK
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State | TX
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Zip | 79410-1812
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Country | US
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Telephone | 806-686-3500
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Fax | 806-701-4184
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | L1532
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License Number State | TX
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