Provider Demographics
NPI:1891094272
Name:BRADSHER, ROBERT WILDER III (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILDER
Last Name:BRADSHER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROB
Other - Middle Name:
Other - Last Name:BRADSHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:251 S CLAYBROOK AVE
Mailing Address - Street 2:2ND FLOOR, MED ED
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104
Mailing Address - Country:US
Mailing Address - Phone:901-516-8255
Mailing Address - Fax:
Practice Address - Street 1:1265 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3415
Practice Address - Country:US
Practice Address - Phone:901-516-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN50878207R00000X, 208M00000X
AR9663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine