Provider Demographics
NPI:1457461733
Name:BRADLEY, MICHAEL BARTON (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BARTON
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 1:3185 W STATE ST
Mailing Address - Street 2:SUITE 2010
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1610
Mailing Address - Country:US
Mailing Address - Phone:423-968-7555
Mailing Address - Fax:423-968-7641
Practice Address - Street 1:3185 W STATE ST
Practice Address - Street 2:SUITE 2010
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1610
Practice Address - Country:US
Practice Address - Phone:423-968-7555
Practice Address - Fax:423-968-7641
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29086207W00000X
VA0101056321207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA382476OtherANTHEM
TN3064606OtherBLUE CROSS BLUE SHIELD
TN3811979Medicare ID - Type Unspecified