Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2935 | CO |
Y | 103TC0700X | Clinical Psychologist | 2935 | CO |
NPI | 1003820028 |
---|---|
Provider Name | Dr. John Mackemer Bradley |
First Address | Denver, CO 80210-3933 |
Second Address | Denver, CO 80210-3933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |