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NPI Code Detail

MEDICARE: BRADLEY GARTH DAVIS DO

MEDICARE: BRADLEY GARTH DAVIS DO
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
1207Q00000XFamily Medicine Physician20A5494CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255321204
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY GARTH DAVIS DO
Provider Business Mailing Address
First Line : 3700 MALL VIEW RD
Second Line : MEDICAL STAFF OFFICE
City : BAKERSFIELD
State : CA
Zip : 93306-3050
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3700 MALL VIEW RD
Second Line : MEDICAL STAFF OFFICE
City : BAKERSFIELD
State : CA
Zip : 93306-3050
Country : US
Telephone Number : 661-328-9831
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 12/02/2021

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