MEDICARE: DR. REBECCA BRADLEY D.O.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207V00000X	Obstetrics & Gynecology Physician	E-11876	AR

General Provider Information

NPI Number	:	1295114486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA BRADLEY D.O.

Provider Business Mailing Address
First Line	:	201 LYONS AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07112-2027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 MALVERN AVE STE 401
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-7779
Country	:	US
Telephone Number	:	501-623-6455
Fax Number	:	501-624-5896

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

Provider Enumeration Date	:	05/21/2015
Last Update Date	:	05/05/2022

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