Provider Demographics
NPI:1508910894
Name:BRADLEY, ROBERT CLAUD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CLAUD
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1455 MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5559
Mailing Address - Country:US
Mailing Address - Phone:970-686-3950
Mailing Address - Fax:970-686-3960
Practice Address - Street 1:1455 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5559
Practice Address - Country:US
Practice Address - Phone:970-686-3950
Practice Address - Fax:970-686-3960
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO19366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1193663Medicaid
COP00944651OtherMEDICARE RAILROAD CARRIER PTAN
COCO307289Medicare PIN
D23593Medicare UPIN
CO1193663Medicaid
C173658Medicare PIN
C289718Medicare PIN