Provider Demographics
NPI:1255327375
Name:BRADBURN, DAVID ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ARTHUR
Last Name:BRADBURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 3RD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-9469
Mailing Address - Country:US
Mailing Address - Phone:503-842-5546
Mailing Address - Fax:
Practice Address - Street 1:980 3RD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-9469
Practice Address - Country:US
Practice Address - Phone:503-842-5546
Practice Address - Fax:503-842-1444
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR117023Medicaid
OR101674Medicare ID - Type Unspecified
OR117023Medicaid