Provider Demographics
NPI:1821088170
Name:BRADLEY, BARRETT BLAKE (MD)
Entity Type:Individual
Prefix:MR
First Name:BARRETT
Middle Name:BLAKE
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 910670
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-0670
Mailing Address - Country:US
Mailing Address - Phone:859-971-4685
Mailing Address - Fax:859-971-4602
Practice Address - Street 1:1780 NICHOLASVILLE RD
Practice Address - Street 2:STE 403
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1400
Practice Address - Country:US
Practice Address - Phone:859-260-2580
Practice Address - Fax:859-260-2585
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2020-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY23312207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64233125Medicaid
KY64233125Medicaid
KYK064170Medicare PIN