Individual
STEPHEN BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
740 MEMORIAL ST, PROSSER, WA 99350-1525
(509) 786-1931
(509) 786-1997
Mailing address
PO BOX 190, TOPPENISH, WA 98948-0190
(509) 865-6175
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA10000296
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306897681
NPI PROSSER MEMORIAL
—
01
—
142805
L & I
WA
01
—
4750BR
REGENCE
WA
01
—
6972
GROUP HEALTH
—
01
—
8296097
CHPW
WA
05
—
8296097
—
WA
Enumeration date
09/06/2006
Last updated
04/18/2008
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