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NPI Code Detail

MEDICARE: MRS. KRISTIN BRIANA BRADFORD M.D.

MEDICARE: MRS. KRISTIN BRIANA 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
1207Q00000XFamily Medicine PhysicianMD150240OR

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 : 1952304396
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTIN BRIANA BRADFORD M.D.
Provider Business Mailing Address
First Line : PO BOX 579
Second Line :
City : CORVALLIS
State : OR
Zip : 97339-0579
Country : US
Telephone Number : 541-766-6835
Fax Number : 541-766-6186
Provider Business Practice Location Address
First Line : 530 NW 27TH ST
Second Line :
City : CORVALLIS
State : OR
Zip : 97330-5223
Country : US
Telephone Number : 541-766-6835
Fax Number : 541-766-6186
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 09/11/2011

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