MEDICARE: DR. THOMAS HAL BRADFORD MD

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	207V00000X	Obstetrics & Gynecology Physician	C7898	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5J353	OTHER	AR	BLUE

General Provider Information

NPI Number	:	1174579833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS HAL BRADFORD MD

Provider Business Mailing Address
First Line	:	3000 N. MARKET AVE.
Second Line	:	SUITE E
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-3507
Country	:	US
Telephone Number	:	479-444-1440
Fax Number	:	479-444-1447

Provider Business Practice Location Address
First Line	:	3000 N. MARKET AVE.
Second Line	:	SUITE E
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-3507
Country	:	US
Telephone Number	:	479-444-1440
Fax Number	:	479-444-1447

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	03/16/2012

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