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1972501401

NPI Code Detail

MEDICARE: BRADLEY JOHN BRADFORD MD

MEDICARE: BRADLEY JOHN BRADFORD 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	208000000X	Pediatrics Physician	ME80414	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10511	OTHER	FL	DIMENSION
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	278678	OTHER	FL	WELLCARE
4	30114893	OTHER	FL	HUMANA
5	238939	OTHER	FL	AMERIGROUP
6	278678	OTHER	FL	HEALTHEASE
7	332659	OTHER	FL	PHC
8	3580558	OTHER	FL	AETNA
9	37543	OTHER	FL	BCBS
10	0610645	OTHER	FL	CIGNA
11	293270	OTHER	FL	AV MED
12	114893	OTHER	FL	HUMANA HMO
13	P3606154	OTHER	FL	OXFORD
14	10467	OTHER	FL	TOTAL HEALTH CHOICE
15	278678	OTHER	FL	STAYWELL
16	FP4185	OTHER	FL	BEECH STREET
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972501401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY JOHN BRADFORD MD

Provider Business Mailing Address
First Line	:	285 SE 5TH AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5206
Country	:	US
Telephone Number	:	561-272-8991
Fax Number	:	561-272-8985

Provider Business Practice Location Address
First Line	:	285 SE 5TH AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5206
Country	:	US
Telephone Number	:	561-272-8991
Fax Number	:	561-272-8985

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	04/22/2008

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Directions to “ BRADLEY JOHN BRADFORD MD” Practice Location

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