MEDICARE: BRADLEY DON RASMUSSEN 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	207N00000X	Dermatology Physician	5663814-1205	UT
2	207N00000X	Dermatology Physician	27555	AZ

General Provider Information

NPI Number	:	1942230925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY DON RASMUSSEN M.D.

Provider Business Mailing Address
First Line	:	4425 E AGAVE RD
Second Line	:	SUITE 148
City	:	PHOENIX
State	:	AZ
Zip	:	85044-0619
Country	:	US
Telephone Number	:	480-704-7546
Fax Number	:	480-704-7549

Provider Business Practice Location Address
First Line	:	4425 E AGAVE RD
Second Line	:	SUITE 148
City	:	PHOENIX
State	:	AZ
Zip	:	85044-0619
Country	:	US
Telephone Number	:	480-704-7546
Fax Number	:	480-704-7549

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	11/12/2015

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