Provider Demographics
NPI:1912042763
Name:BRADLEY, JAY CAMERON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:CAMERON
Last Name:BRADLEY
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 1:5109 80TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3017
Mailing Address - Country:US
Mailing Address - Phone:806-792-5900
Mailing Address - Fax:806-792-6092
Practice Address - Street 1:5109 80TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3017
Practice Address - Country:US
Practice Address - Phone:806-792-5900
Practice Address - Fax:806-792-6092
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2267207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195329103Medicaid
NM38305551OtherNM MEDICAID
TX8CV658OtherBLUE SHIELD
TXTXB133285Medicare PIN
TX8CV658OtherBLUE SHIELD