Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 1620901205 | UT |
N | 207NS0135X | Procedural Dermatology | 1620908905 | UT |
NPI | 1386681005 |
---|---|
Provider Name | Dr. Rulon Ralph Bradley |
First Address | Salt Lake City, UT 84117-8055 |
Second Address | Salt Lake City, UT 84107-7257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0300062 | AARP/UNITED HEALTH CARE (01) | UT |
0300062 | UHC EMPLOYEE CLAIMS (01) | UT |
0300062 | UNITED HEALTH CARE (01) | UT |
0300062 | UNITED MED CHOICE (01) | UT |
0391841 | UNITED HEALTH CARE/AM (01) | UT |
0391841 | UNITED HEALTH CARE/PLUS (01) | UT |
1181 | PUBLIC EMPLOYEES HEALTH (01) | UT |
123482 | ALTIUS (01) | UT |
123482 | ALTIUS SUMMIT CARE (01) | UT |
1424448 | FIRST HEALTH (01) | UT |
4116634 | AETNA (01) | UT |
E00025 | (02) | UT |