Provider Demographics
NPI:1700888799
Name:BRADLEY, JOE FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:FRANK
Last Name:BRADLEY
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 1:7 OFFICE PARK DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3843
Mailing Address - Country:US
Mailing Address - Phone:501-219-2412
Mailing Address - Fax:
Practice Address - Street 1:7 OFFICE PARK DR
Practice Address - Street 2:SUITE 120
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3843
Practice Address - Country:US
Practice Address - Phone:501-219-2412
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5176174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR50589OtherBLUE SHIELD PROVIDER NUMB
AR50589OtherBLUE SHIELD PROVIDER NUMB
AR50589Medicare ID - Type Unspecified