Provider Demographics
NPI:1609189398
Name:MARK BRADSHAW MD PC
Entity Type:Organization
Organization Name:MARK BRADSHAW MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-482-2175
Mailing Address - Street 1:238 E MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1831
Mailing Address - Country:US
Mailing Address - Phone:541-482-2175
Mailing Address - Fax:
Practice Address - Street 1:1208 BEALL LN
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-1573
Practice Address - Country:US
Practice Address - Phone:541-664-5151
Practice Address - Fax:877-772-9433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD247072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty