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General NPI Number Information
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NPI Number | 1194740217
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Entity Type | Individual
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Provider Name | LETITIA L BRADFORD M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 1901 RED ROCK DR
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City | GALLUP
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State | NM
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Zip | 87301-5683
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Country | US
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Telephone | 505-863-7309
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 RED ROCK DR
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City | GALLUP
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State | NM
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Zip | 87301-5683
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Country | US
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Telephone | 505-863-7309
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Fax |
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A70194
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | LT-2827
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 14581
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License Number State | NH
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD2020-0288
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License Number State | NM
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