Provider Demographics
NPI:1265793640
Name:ANDERSON, BRADLEY B (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:B
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 41150
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85274-1150
Mailing Address - Country:US
Mailing Address - Phone:480-425-2160
Mailing Address - Fax:480-351-8797
Practice Address - Street 1:1111 E MCDOWELL RD
Practice Address - Street 2:LL2
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2612
Practice Address - Country:US
Practice Address - Phone:602-839-2296
Practice Address - Fax:602-839-2084
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR73368207R00000X
AZ52638207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine