Provider Demographics
NPI:1235295866
Name:BRADSHAW, ELIZABETH PLEASANTS (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:PLEASANTS
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 FALLS BLVD S
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-3514
Mailing Address - Country:US
Mailing Address - Phone:870-238-2321
Mailing Address - Fax:870-238-0114
Practice Address - Street 1:710 FALLS BLVD S
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-3514
Practice Address - Country:US
Practice Address - Phone:870-238-2321
Practice Address - Fax:870-238-0114
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4904208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE4904OtherSTATE LICENSE NUMBER