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General NPI Number Information
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NPI Number | 1902893019
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Entity Type | Individual
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Provider Name | J. COLTON BRADSHAW M.D.11/11/1952
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Gender | Male
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 2001 N JEFFERSON AVE SUITE 300
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City | MOUNT PLEASANT
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State | TX
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Zip | 75455-2371
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Country | US
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Telephone | 903-572-9823
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Fax | 903-572-4812
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Provider Business Mailing Address
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Address Line | 2001 N JEFFERSON AVE SUITE 300
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City | MOUNT PLEASANT
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State | TX
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Zip | 75455-2371
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Country | US
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Telephone | 903-572-9823
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Fax | 903-572-4812
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | F8808
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License Number State | TX
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