Provider Demographics
NPI:1619362779
Name:BRADSHAW, JOSHUA BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:BRIAN
Last Name:BRADSHAW
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:PO BOX 5546
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5546
Mailing Address - Country:US
Mailing Address - Phone:801-475-3500
Mailing Address - Fax:801-475-3494
Practice Address - Street 1:1551 RENAISSANCE TOWNE DR STE 310
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7671
Practice Address - Country:US
Practice Address - Phone:801-295-5581
Practice Address - Fax:801-295-9253
Is Sole Proprietor?:No
Enumeration Date:2015-04-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT117035791205207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1619362779Medicaid