Provider Demographics
NPI:1275708877
Name:PRESCOTT, BRADFORD TRUE (BRADFORD PRESCOTT)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:TRUE
Last Name:PRESCOTT
Suffix:
Gender:M
Credentials:BRADFORD PRESCOTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N WIGET LN STE 100
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5909
Mailing Address - Country:US
Mailing Address - Phone:925-935-9717
Mailing Address - Fax:
Practice Address - Street 1:100 N WIGET LN STE 100
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-5909
Practice Address - Country:US
Practice Address - Phone:925-935-9717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49194208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery