MEDICARE: PAUL BRADLEY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	OA60593209	WA

General Provider Information

NPI Number	:	1013311679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL BRADLEY PA-C

Provider Business Mailing Address
First Line	:	11306 BRIDGEPORT WAY SW
Second Line	:	STE D
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3037
Country	:	US
Telephone Number	:	425-774-1538
Fax Number	:

Provider Business Practice Location Address
First Line	:	11306 BRIDGEPORT WAY SW
Second Line	:	STE D
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3037
Country	:	US
Telephone Number	:	425-774-1538
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2014
Last Update Date	:	09/13/2019

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Directions to “ PAUL BRADLEY PA-C” Practice Location

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