MEDICARE: WILLIAM B BRADFORD M.D.

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	2085R0001X	Radiation Oncology Physician	MD0000025802	TN

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	4019082	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1396748877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM B BRADFORD M.D.

Provider Business Mailing Address
First Line	:	DEPT 0765
Second Line	:	PO BOX 11407
City	:	BIRMINGHAM
State	:	AL
Zip	:	35246-0765
Country	:	US
Telephone Number	:	256-383-3325
Fax Number	:	480-212-8451

Provider Business Practice Location Address
First Line	:	2114 N JACKSON ST
Second Line	:
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-2208
Country	:	US
Telephone Number	:	931-454-9423
Fax Number	:	931-454-9690

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/03/2011

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