Provider Demographics
NPI:1528195641
Name:WILLIAMS, BRADLEY JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JOSEPH
Last Name:WILLIAMS
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 1:8700 E VISTA BONITA DR
Mailing Address - Street 2:STE 150
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3200
Mailing Address - Country:US
Mailing Address - Phone:602-992-8100
Mailing Address - Fax:602-992-8101
Practice Address - Street 1:16601 N 40TH ST
Practice Address - Street 2:SUITE 216
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3345
Practice Address - Country:US
Practice Address - Phone:602-992-8100
Practice Address - Fax:602-992-8101
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14677207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z0000BGMNLMedicare PIN
037844Medicare UPIN