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General NPI Number Information
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NPI Number | 1396982930
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Entity Type | Organization
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Legal Business Name | R RALPH BRADLEY M D PC
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Dates
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Enumeration Date | 01/20/2009
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Last Update Date | 02/12/2009
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Provider Practice Location Address
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Address Line | 166 E 5900 S B-111
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City | MURRAY
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State | UT
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Zip | 84107-7257
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Country | US
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Telephone | 801-268-9672
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Fax | 801-266-9390
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Provider Business Mailing Address
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Address Line | 166 E 5900 S B-111
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City | MURRAY
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State | UT
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Zip | 84107-7257
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Country | US
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Telephone | 801-268-9672
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Fax | 801-266-9390
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Authorized Official
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Title or Position | OWNER
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Name | DR. RALPH BRADLEY
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Credential | M.D.
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Telephone | 801-268-9672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 162090-1205
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License Number State | UT
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