Provider Demographics
NPI:1245604768
Name:BRADSHAW, CHRISTOPHER MICHAEL (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2034 E SOUTHERN AVE STE D
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7511
Mailing Address - Country:US
Mailing Address - Phone:480-923-6200
Mailing Address - Fax:602-419-3101
Practice Address - Street 1:2034 E SOUTHERN AVE STE D
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7511
Practice Address - Country:US
Practice Address - Phone:480-923-6200
Practice Address - Fax:602-419-3101
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6128363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical