Provider Demographics
NPI:1134309420
Name:BRADFORD, SAMUEL ALLEN JR (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ALLEN
Last Name:BRADFORD
Suffix:JR
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 1:9315 BALADA ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2333
Mailing Address - Country:US
Mailing Address - Phone:305-667-4511
Mailing Address - Fax:
Practice Address - Street 1:6141 SUNSET DR
Practice Address - Street 2:SUITE 401
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5028
Practice Address - Country:US
Practice Address - Phone:305-667-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME10888207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology