Provider Demographics
NPI:1124206487
Name:JACKSON, BRADLEY A (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:A
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:300 PASTEUR DR, ROOM H3630, MC: 5642
Mailing Address - Street 2:STANFORD UNIVERSITY MED CTR, DEPT. OF INT. RADIOLOGY
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5642
Mailing Address - Country:US
Mailing Address - Phone:626-840-4287
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR, ROOM H3630, MC: 5642
Practice Address - Street 2:STANFORD UNIVERSITY MED CTR, DEPT. OF INT. RADIOLOGY
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5642
Practice Address - Country:US
Practice Address - Phone:626-840-4287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1153262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology