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Individual

DEWAYNE THOMAS BRADLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
904 7TH AVE, SEATTLE, WA 98104-1132
(206) 329-1760
Mailing address
904 7TH AVE, SEATTLE, WA 98104-1132
(206) 329-1760

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MD00043530
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0039572
LABOR & INDUSTRY
WA
01
8050BR
BLUE SHIELD
WA
05
8392664
WA
01
P00285478
RAILROAD MEDICARE
01
US7329597
AETNA/USHC SPECIALIST
WA
Enumeration date
08/30/2006
Last updated
04/18/2012
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