Individual
JARED ALLEN BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5332 HERON CT, OKLAHOMA CITY, OK 73179-3403
(405) 306-9641
Mailing address
1000 N LEE AVE, OKLAHOMA CITY, OK 73102-1036
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5108
OK
363A00000X
Physician Assistant
—
—
Other
Enumeration date
07/20/2023
Last updated
03/19/2024
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