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General NPI Number Information
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NPI Number | 1740504927
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Entity Type | Organization
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Legal Business Name | DAVID C. BRADSHAW, M.D. APC
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | 19830 LAKE CHABOT RD SUITE C
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-4063
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Country | US
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Telephone | 510-964-0458
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Fax | 510-964-0476
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Provider Business Mailing Address
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Address Line | PO BOX 1460
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City | SUISUN CITY
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State | CA
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Zip | 94585-4460
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Country | US
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Telephone | 510-964-0458
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Fax | 510-964-0476
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. DAVID CLIETT BRADSHAW
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Credential | M.D.
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Telephone | 510-964-0458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | C38599
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License Number State | CA
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