Individual
DR. BRADLEY DEE MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-BC, DC
Contact information
Practice address
559 W WASHINGTON ST, BURNS, OR 97720-1441
(541) 573-2074
Mailing address
559 W WASHINGTON ST, BURNS, OR 97720-1441
(541) 573-2074
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1573A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500763900
—
OR
Enumeration date
10/27/2009
Last updated
12/03/2020
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