Provider Demographics
NPI:1821292590
Name:BRADLEY, MELISSA R (DO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:R
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:C
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2424 N. WYATT DRIVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-545-0608
Mailing Address - Fax:520-795-0354
Practice Address - Street 1:6565 E. CARONDELET DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2158
Practice Address - Country:US
Practice Address - Phone:520-323-0333
Practice Address - Fax:520-323-5036
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202751207V00000X
AZ6352207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ930677Medicaid
E78293Medicare UPIN