Provider Demographics
NPI:1417272188
Name:BRADLEY, KIERST LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:KIERST
Middle Name:LEIGH
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 HILYARD ST
Mailing Address - Street 2:SUITE 440
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8122
Mailing Address - Country:US
Mailing Address - Phone:458-205-6061
Mailing Address - Fax:541-687-6067
Practice Address - Street 1:1200 HILYARD ST
Practice Address - Street 2:SUITE 440
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8122
Practice Address - Country:US
Practice Address - Phone:458-205-6061
Practice Address - Fax:541-687-6067
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD162811208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500659137Medicaid