Individual
BRADLEY TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
808 CARTER ST SE, ARDMORE, OK 73401-8524
(580) 504-9468
Mailing address
808 CARTER ST SE, ARDMORE, OK 73401-8524
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4463
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/04/2020
Last updated
11/12/2020
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