Provider Demographics
NPI:1134426315
Name:BRADSHAW, DAVID LAMAR (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LAMAR
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14421 S LIBBY ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5719
Mailing Address - Country:US
Mailing Address - Phone:405-691-2898
Mailing Address - Fax:405-635-8380
Practice Address - Street 1:809 SW 89TH ST
Practice Address - Street 2:STE. C
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9360
Practice Address - Country:US
Practice Address - Phone:405-635-8378
Practice Address - Fax:405-635-8380
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1772207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology