Provider Demographics
NPI:1386681005
Name:BRADLEY, RULON RALPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RULON
Middle Name:RALPH
Last Name:BRADLEY
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 1:4659 STILLWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-8055
Mailing Address - Country:US
Mailing Address - Phone:801-278-5902
Mailing Address - Fax:
Practice Address - Street 1:166 E 5900 S
Practice Address - Street 2:SUITE B-111
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-7257
Practice Address - Country:US
Practice Address - Phone:801-268-9672
Practice Address - Fax:801-266-9390
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1620901205207N00000X
UT1620908905207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0391841OtherUNITED HEALTH CARE/AM
UT0391841OtherUNITED HEALTH CARE/PLUS
UT1424448OtherFIRST HEALTH
UT0300062OtherAARP/UNITED HEALTH CARE
UT0300062OtherUHC EMPLOYEE CLAIMS
UT1181OtherPUBLIC EMPLOYEES HEALTH
UT0300062OtherUNITED HEALTH CARE
UT4116634OtherAETNA
UT0300062OtherUNITED MED CHOICE
UT123482OtherALTIUS SUMMIT CARE
UT123482OtherALTIUS
UT0391841OtherUNITED HEALTH CARE/PLUS