Provider Demographics
NPI:1497026397
Name:EDWARDS, BRADLEY ALAN (PA)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:ALAN
Last Name:EDWARDS
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Gender:M
Credentials:PA
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-636-7650
Mailing Address - Fax:405-636-7743
Practice Address - Street 1:4221 S WESTERN AVE
Practice Address - Street 2:SUITE 3030
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3447
Practice Address - Country:US
Practice Address - Phone:405-636-7650
Practice Address - Fax:405-636-7743
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2017-07-19
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Provider Licenses
StateLicense IDTaxonomies
OK2104363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant