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General NPI Number Information
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NPI Number | 1093791964
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Entity Type | Individual
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Provider Name | JOHN ADDITON BRADFORD M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 925 UNION ST STE 3
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City | BANGOR
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State | ME
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Zip | 04401-3051
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Country | US
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Telephone | 207-973-9980
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Fax | 207-973-7515
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Provider Business Mailing Address
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Address Line | 43 WHITING HILL RD STE 300
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City | BREWER
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State | ME
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Zip | 04412-1006
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Country | US
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Telephone | 207-973-5035
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Fax | 207-973-5042
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 011526
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License Number State | ME
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