Provider Demographics
NPI:1467637124
Name:BRADLEY J ADAMS D P M
Entity type:Organization
Organization Name:BRADLEY J ADAMS D P M
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D P M/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:D P M
Authorized Official - Phone:419-337-8897
Mailing Address - Street 1:734 S SHOOP AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1707
Mailing Address - Country:US
Mailing Address - Phone:419-337-8897
Mailing Address - Fax:419-337-4910
Practice Address - Street 1:734 S SHOOP AVE
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1707
Practice Address - Country:US
Practice Address - Phone:419-337-8897
Practice Address - Fax:419-337-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH605732OtherBUCKEYE CHP
OH02037OtherPARAMOUNT
OH000000115549OtherANTHEM
OH02037OtherPARAMOUNT