Provider Demographics
NPI:1790891752
Name:BRADSHAW, BARBARA SUE (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:SUE
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9229 LBJ FWY STE 250
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4403
Mailing Address - Country:US
Mailing Address - Phone:817-589-4628
Mailing Address - Fax:
Practice Address - Street 1:9229 LBJ FWY STE 250
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4403
Practice Address - Country:US
Practice Address - Phone:817-589-4628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096293801Medicaid
TX096293805Medicaid
TX096293809Medicaid
TX096293804Medicaid
TX096293806Medicaid
TX096293807Medicaid
TX096293808Medicaid
TX8L9506Medicare PIN
TX8L9383Medicare PIN
TX00N10LMedicare ID - Type Unspecified
TX096293805Medicaid
TX096293804Medicaid
TX096293801Medicaid
TX8L1821Medicare PIN
TXF58703Medicare UPIN