Provider Demographics
NPI:1164414116
Name:DOWNING, BRADLEY C (DO)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:C
Last Name:DOWNING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9061 E BASELINE RD
Mailing Address - Street 2:STE B101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-7761
Mailing Address - Country:US
Mailing Address - Phone:480-926-3233
Mailing Address - Fax:480-889-8310
Practice Address - Street 1:9061 E BASELINE RD
Practice Address - Street 2:STE B101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-7761
Practice Address - Country:US
Practice Address - Phone:480-926-3233
Practice Address - Fax:480-889-8310
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ240218Medicaid
AZ66159Medicare ID - Type Unspecified
D10265Medicare UPIN