Provider Demographics
NPI:1326041591
Name:BRADLEY, SCOTT T (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:T
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1501
Mailing Address - Country:US
Mailing Address - Phone:662-243-1486
Mailing Address - Fax:662-328-5000
Practice Address - Street 1:425 HOSPITAL DR
Practice Address - Street 2:STE 8
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1938
Practice Address - Country:US
Practice Address - Phone:662-328-2061
Practice Address - Fax:662-328-5000
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS128223207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00113517Medicaid
MS00113517Medicaid
MSF77893Medicare UPIN