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General NPI Number Information
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NPI Number | 1588007843
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Entity Type | Individual
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Provider Name | BRADLEY ALEXANDER BIGFORD NP-C
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Gender | Male
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Dates
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Enumeration Date | 04/16/2013
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Last Update Date | 05/11/2024
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Provider Practice Location Address
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Address Line | 3090 E GENTRY WAY STE 210
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City | MERIDIAN
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State | ID
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Zip | 83642-3550
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Country | US
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Telephone | 986-224-8280
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Fax | 844-268-7286
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Provider Business Mailing Address
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Address Line | PO BOX 44953
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City | BOISE
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State | ID
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Zip | 83711-0953
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Country | US
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Telephone | 208-895-6729
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Fax | 208-855-5921
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP-1252A
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License Number State | ID
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