Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 26170 | TN |
Y | 111NI0900X | Internist | 26170 | TN |
NPI | 1003800293 |
---|---|
Provider Name | Dr. Marcia Bradford |
First Address | Memphis, TN 38126-5310 |
Second Address | Memphis, TN 38126-5310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2005 |
Last Update Date | 18/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3090709 | (05) | TN |
G01781 | (02) | TN |