Provider Demographics
NPI:1174963995
Name:BRADSHAW, JOSEPH DANIEL JR (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DANIEL
Last Name:BRADSHAW
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:10510 JEFFERSON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-3102
Mailing Address - Country:US
Mailing Address - Phone:757-594-3800
Mailing Address - Fax:757-594-3818
Practice Address - Street 1:10510 JEFFERSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-3102
Practice Address - Country:US
Practice Address - Phone:757-594-3800
Practice Address - Fax:757-594-3818
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
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Provider Licenses
StateLicense IDTaxonomies
VA0116026366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine