Provider Demographics
NPI:1639270119
Name:BRADSHAW, MAJOR R (PHD)
Entity Type:Individual
Prefix:
First Name:MAJOR
Middle Name:R
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:PHD
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 4850
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4850
Mailing Address - Country:US
Mailing Address - Phone:713-798-5995
Mailing Address - Fax:713-798-1898
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1801
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-798-5975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33154103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00352421Medicare PIN
C17429Medicare UPIN
TX8J2440Medicare PIN