Provider Demographics
NPI:1396748877
Name:BRADFORD, WILLIAM B (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:BRADFORD
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:DEPT 0765
Mailing Address - Street 2:PO BOX 11407
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0765
Mailing Address - Country:US
Mailing Address - Phone:256-383-3325
Mailing Address - Fax:480-212-8451
Practice Address - Street 1:2114 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2208
Practice Address - Country:US
Practice Address - Phone:931-454-9423
Practice Address - Fax:931-454-9690
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000258022085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3867811Medicaid
TN4019082OtherBLUE CROSS BLUE SHIELD
F74311Medicare UPIN
TN38678111Medicare PIN
TN3867811Medicaid