Provider Demographics
NPI:1164459707
Name:BRADSHER, STEVEN ALLEN (IDC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALLEN
Last Name:BRADSHER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL UNDERSEA MEDICAL INSTITUTE
Mailing Address - Street 2:P.O. BOX 159
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06349-5159
Mailing Address - Country:US
Mailing Address - Phone:360-621-4268
Mailing Address - Fax:
Practice Address - Street 1:3350 NARROWS VIEW LN NE
Practice Address - Street 2:# 202
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-6605
Practice Address - Country:US
Practice Address - Phone:360-621-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman