Provider Demographics
NPI:1649204918
Name:BRADSHAW, WILLIAM L JR (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:BRADSHAW
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:326 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-3526
Mailing Address - Country:US
Mailing Address - Phone:719-486-0943
Mailing Address - Fax:719-486-7159
Practice Address - Street 1:822 W 4TH ST
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461-3861
Practice Address - Country:US
Practice Address - Phone:719-486-7164
Practice Address - Fax:719-486-7159
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO44701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B33079Medicare UPIN