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General NPI Number Information
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NPI Number | 1821271255
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Entity Type | Organization
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Legal Business Name | JOHN K. BRADWAY, M.D., P.C.
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 10213 N 92ND ST SUITE 101
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4561
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Country | US
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Telephone | 480-860-6005
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Fax | 480-860-1882
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Provider Business Mailing Address
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Address Line | 10213 N 92ND ST SUITE 101
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4561
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Country | US
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Telephone | 480-860-6005
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Fax | 480-860-1882
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN K. BRADWAY
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Credential | MD
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Telephone | 480-860-6005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 2150
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 17615
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License Number State | AZ
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