Provider Demographics
NPI:1700879277
Name:BRADBURY, RICHARD L (DPM)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:BRADBURY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 E IRON AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3235
Mailing Address - Country:US
Mailing Address - Phone:785-825-2900
Mailing Address - Fax:785-825-2839
Practice Address - Street 1:1529 E IRON AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3235
Practice Address - Country:US
Practice Address - Phone:785-825-2900
Practice Address - Fax:785-825-2839
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00240213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100227100BMedicaid
KS4831960001Medicare NSC
KS114090Medicare PIN
KST01485Medicare UPIN