=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568672095
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERIN BRADLEY FAMILY MEDICINE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4909 S. ALMA SCHOOL RD SUITE 4
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-883-3011
-----------------------------------------------------
Fax | 480-802-3874
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4909 S. ALMA SCHOOL RD SUITE 4
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-883-3011
-----------------------------------------------------
Fax | 480-802-3874
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OWNER PHYSICIAN
-----------------------------------------------------
Name | DR. ERIN H BRADLEY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 480-883-3011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | AZ21647
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------