MEDICARE: JAMES L BRADLEY 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	2085R0202X	Diagnostic Radiology Physician	00007603	AL

General Provider Information

NPI Number	:	1538144233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES L BRADLEY MD

Provider Business Mailing Address
First Line	:	PO BOX 1328
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35502-1328
Country	:	US
Telephone Number	:	205-221-3523
Fax Number	:	205-221-3560

Provider Business Practice Location Address
First Line	:	3400 HIGHWAY 78 E
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35501-8950
Country	:	US
Telephone Number	:	205-221-3523
Fax Number	:	205-221-3560

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	07/08/2007

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