Provider Demographics
NPI:1780645150
Name:BRADLEY, A. JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:A.
Middle Name:JAMES
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 1:1001 SE MONTEREY COMMONS BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3329
Mailing Address - Country:US
Mailing Address - Phone:772-286-9400
Mailing Address - Fax:772-283-3832
Practice Address - Street 1:1001 SE MONTEREY COMMONS BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3329
Practice Address - Country:US
Practice Address - Phone:772-286-9400
Practice Address - Fax:772-283-3832
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61829174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370597800Medicaid
FL15139WMedicare ID - Type Unspecified
FL370597800Medicaid