Provider Demographics
NPI:1740627488
Name:STOKES, BRADLEY JAY (DO)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JAY
Last Name:STOKES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3205 N ACADEMY BLVD
Mailing Address - Street 2:STE 130
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5152
Mailing Address - Country:US
Mailing Address - Phone:513-576-7700
Mailing Address - Fax:513-707-5692
Practice Address - Street 1:631 E STATE ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-1437
Practice Address - Country:US
Practice Address - Phone:937-378-6387
Practice Address - Fax:937-378-4253
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0061641207Q00000X
OH34.011946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0121057Medicaid
OHH512730Medicare PIN
OHH447520Medicare PIN