Individual
MR. GARY BRADFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
928 N YORK ST, SUITE 20, MUSKOGEE, OK 74403-3123
(918) 913-9109
(918) 913-9112
Mailing address
928 N YORK ST, SUITE 20, MUSKOGEE, OK 74403-3123
(918) 913-9109
(918) 913-9112
Taxonomy
Speciality
Code
Description
License number
State
132700000X
Dietary Manager
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
380025
—
OK
Enumeration date
03/15/2011
Last updated
10/14/2011
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