Individual
EDWARD WILLARD BRADSHAW III
Active
Individual
EDWARD WILLARD BRADSHAW III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5357
AZ
363AS0400X
Surgical Physician Assistant
PA2576
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040403
—
AZ
05
—
291637100
—
FL
01
—
P00221346
RAILROAD MEDICARE
—
Enumeration date
04/07/2006
Last updated
06/29/2020
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