Provider Demographics
NPI:1841224805
Name:KESLING, BRADHAM HANKS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADHAM
Middle Name:HANKS
Last Name:KESLING
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 1:5525 GROSSMONT CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3009
Mailing Address - Country:US
Mailing Address - Phone:619-644-6500
Mailing Address - Fax:619-644-6526
Practice Address - Street 1:5525 GROSSMONT CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3009
Practice Address - Country:US
Practice Address - Phone:619-644-6500
Practice Address - Fax:619-644-6526
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24051207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G240510Medicaid
CAWG24051EMedicare ID - Type UnspecifiedMEDICARE ID NUMBER
CAA42145Medicare UPIN