Provider Demographics
NPI:1942690177
Name:BRADFORD, JAMES CANNON III (RN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CANNON
Last Name:BRADFORD
Suffix:III
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4229 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3038
Mailing Address - Country:US
Mailing Address - Phone:623-293-2387
Mailing Address - Fax:
Practice Address - Street 1:2601 E. ROOSEVELT STREET
Practice Address - Street 2:MARICOPA INTEGRATED HEALTH SYSTEM
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008
Practice Address - Country:US
Practice Address - Phone:602-344-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN140572163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse