Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | C6376 | AR |
NPI | 1033180229 |
---|---|
Provider Name | Dr. Daniel S Bradford |
First Address | Fayetteville, AR 72703-4005 |
Second Address | Rogers, AR 72758-8602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 30/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100080660A | (05) | OK |
113914001 | (05) | AR |
203802103 | (05) | MO |
B89997 | (02) | AR |