Provider Demographics
NPI:1235235110
Name:WELCH, BRADLEY WAYNE (BS, RVT, RDCS)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:WAYNE
Last Name:WELCH
Suffix:
Gender:M
Credentials:BS, RVT, RDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5294 KINGS RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-8873
Mailing Address - Country:US
Mailing Address - Phone:580-226-0583
Mailing Address - Fax:580-223-4899
Practice Address - Street 1:720 N COMMERCE ST # 226
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-3915
Practice Address - Country:US
Practice Address - Phone:580-223-4770
Practice Address - Fax:580-223-4899
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
Not Answered2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731512719001OtherBLUECROSS BLUESHIELD