Provider Demographics
NPI:1861652893
Name:BRADLEY, NATHAN (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:920 STANTON L. YOUNG BLVD.
Mailing Address - Street 2:WP2140
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104
Mailing Address - Country:US
Mailing Address - Phone:405-271-6900
Mailing Address - Fax:405-271-3118
Practice Address - Street 1:825 NE 10TH ST.
Practice Address - Street 2:STE. 5F
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-8156
Practice Address - Fax:405-271-6219
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2021-04-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK26313208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS107439Medicare PIN