Provider Demographics
NPI:1245267442
Name:BRADFORD, TODD HAROLD (DO)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:HAROLD
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11231 US HIGHWAY 1
Mailing Address - Street 2:BOX 143
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3216
Mailing Address - Country:US
Mailing Address - Phone:561-625-8955
Mailing Address - Fax:561-776-6154
Practice Address - Street 1:1210 S OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7205
Practice Address - Country:US
Practice Address - Phone:561-625-8955
Practice Address - Fax:561-776-6154
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG18310Medicare UPIN
FL06564Medicare ID - Type Unspecified