Provider Demographics
NPI:1023455441
Name:BRADLEY, JOHN F (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
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 1:30 W SPRING ST FL 5
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-2241
Mailing Address - Country:US
Mailing Address - Phone:614-466-6239
Mailing Address - Fax:614-728-0472
Practice Address - Street 1:30 W SPRING ST FL 5
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-2241
Practice Address - Country:US
Practice Address - Phone:614-466-6239
Practice Address - Fax:614-728-0472
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049656207PE0004X, 207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0616604Medicaid
OH0616604Medicaid