Provider Demographics
NPI:1639241326
Name:CROFT, BRADFORD (DO)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:
Last Name:CROFT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E CEDAR AVE
Mailing Address - Street 2:STE A-3
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1630
Mailing Address - Country:US
Mailing Address - Phone:928-774-2788
Mailing Address - Fax:928-774-0123
Practice Address - Street 1:1515 E CEDAR AVE
Practice Address - Street 2:SUITE A-3
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1630
Practice Address - Country:US
Practice Address - Phone:928-774-2788
Practice Address - Fax:928-774-0123
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0067990OtherBCBS
AZ202101Medicaid
AZ0000BGMMMMedicare ID - Type Unspecified
97083Medicare UPIN