Provider Demographics
NPI:1720706104
Name:BRADNER, JG (MD)
Entity Type:Individual
Prefix:
First Name:JG
Middle Name:
Last Name:BRADNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA-GRACE
Other - Middle Name:
Other - Last Name:BRADNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1411 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1018
Mailing Address - Country:US
Mailing Address - Phone:510-535-7313
Mailing Address - Fax:
Practice Address - Street 1:1411 E 31ST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1018
Practice Address - Country:US
Practice Address - Phone:510-535-7313
Practice Address - Fax:510-437-4800
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program