Provider Demographics
NPI:1407846272
Name:BRADLEY, ERIN H (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:H
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 S. ALMA SCHOOL ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248
Mailing Address - Country:US
Mailing Address - Phone:480-883-3011
Mailing Address - Fax:480-802-3874
Practice Address - Street 1:4909 S. ALMA SCHOOL ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248
Practice Address - Country:US
Practice Address - Phone:480-883-3011
Practice Address - Fax:480-802-3874
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21647174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF25629Medicare UPIN