Provider Demographics
NPI:1669636031
Name:BRADSHAW, TODD WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:WESLEY
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 1:1100 S COULTER ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1836
Mailing Address - Country:US
Mailing Address - Phone:806-468-9700
Mailing Address - Fax:806-468-9771
Practice Address - Street 1:1100 S COULTER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1836
Practice Address - Country:US
Practice Address - Phone:806-468-9700
Practice Address - Fax:806-468-9771
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8617390200000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program