Provider Demographics
NPI:1033152343
Name:BRADFORD, WILLIAM S (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27323-0150
Mailing Address - Country:US
Mailing Address - Phone:336-349-4024
Mailing Address - Fax:336-349-6904
Practice Address - Street 1:617 S MAIN ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5019
Practice Address - Country:US
Practice Address - Phone:336-349-4024
Practice Address - Fax:336-349-6904
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29079208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC203579AOtherINDIVIDUAL NPI MEDICARE IDENTIFIER
NC7917408Medicaid
NC2337564Medicare ID - Type Unspecified
NC203579AOtherINDIVIDUAL NPI MEDICARE IDENTIFIER