Individual
BRADLEY GLEN DEMPSEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
902 LAKEVIEW AVE, PUEBLO, CO 81004-3597
(719) 557-5855
(719) 557-5097
Mailing address
902 LAKEVIEW AVE, PUEBLO, CO 81004-3597
(719) 557-5855
(719) 557-5097
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
6206
NE
207Q00000X
Family Medicine Physician
Primary
DR.0052763
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
313101YSS8
MEDICARE PTAN
CO
05
—
97055280
—
CO
01
—
P01528181
MEDICARE RAILROAD
CO
Enumeration date
05/13/2009
Last updated
10/25/2016
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