Provider Demographics
NPI:1811990468
Name:BRADSHAW, DAVID C (MD PC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1013
Mailing Address - Country:US
Mailing Address - Phone:415-750-5761
Mailing Address - Fax:415-666-0210
Practice Address - Street 1:19830 LAKE CHABOT RD
Practice Address - Street 2:STE C
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4063
Practice Address - Country:US
Practice Address - Phone:510-537-7873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC385990208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C385990Medicaid
CA00C385990Medicaid
CAA36961Medicare UPIN