Provider Demographics
NPI:1205478914
Name:BRADFORD, SPENCER A (PA-S2)
Entity type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:A
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:PA-S2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LAMKIN ST
Mailing Address - Street 2:APT 101
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3558
Mailing Address - Country:US
Mailing Address - Phone:719-543-6633
Mailing Address - Fax:719-543-6655
Practice Address - Street 1:620 W LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1508
Practice Address - Country:US
Practice Address - Phone:970-978-7005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant