Provider Demographics
NPI:1891806832
Name:ANDERSON, BRADFORD A (MD)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:A
Last Name:ANDERSON
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 1:8701 CAMINO MEDIA STE C
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1336
Mailing Address - Country:US
Mailing Address - Phone:661-324-4737
Mailing Address - Fax:661-324-3490
Practice Address - Street 1:2441 F ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3821
Practice Address - Country:US
Practice Address - Phone:661-324-4716
Practice Address - Fax:661-321-0499
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG602652081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR770255255OtherTAX ID
AR770255255OtherTAX ID