Provider Demographics
NPI:1548392558
Name:HALLIDAY, BRADFORD E (MD)
Entity Type:Individual
Prefix:MR
First Name:BRADFORD
Middle Name:E
Last Name:HALLIDAY
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 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:9003 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6709
Practice Address - Country:US
Practice Address - Phone:480-323-3383
Practice Address - Fax:480-323-3358
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25522207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ539736Medicaid
AZ53973602Medicaid
AZ53973601Medicaid
AZZ61128Medicare PIN
AZZ61127Medicare PIN
AZ53973602Medicaid
G23324Medicare UPIN
AZ53973601Medicaid
AZ220031155Medicare PIN