Individual
RUSSELL D BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 491-6482
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 491-6482
Taxonomy
Speciality
Code
Description
License number
State
2080P0208X
Pediatric Infectious Diseases Physician
Primary
23648
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009912727
—
AL
05
—
009919575
—
AL
05
—
009919585
—
AL
01
—
051545309
BCBS
AL
Enumeration date
01/25/2007
Last updated
06/08/2012
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