Provider Demographics
NPI:1508950296
Name:BRADLEY, STEPHEN K (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:K
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 1:1795 S DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2562
Mailing Address - Country:US
Mailing Address - Phone:801-860-5905
Mailing Address - Fax:855-242-1691
Practice Address - Street 1:1795 S DEVONSHIRE DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-2562
Practice Address - Country:US
Practice Address - Phone:801-860-5905
Practice Address - Fax:855-242-1691
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT172488-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTPRA07396OtherMOLINA
UTQM0000075886OtherALTIUS
NV002086464Medicaid
UT17839OtherDESERET MUTUAL
WY103500200Medicaid
UT1502954OtherUMWA
UT44140OtherHEALTHY U
AZ820771Medicaid
UT107006512102OtherIHC
UT73544OtherPEHP
ID806727300Medicaid
UT2090168OtherUNITED HEALTHCARE
UT870545614SB3OtherEDUCATORS MUTUAL
NV002086464Medicaid
UT73544OtherPEHP
UTD20291Medicare UPIN