Individual
JERAMIE BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MOT
Contact information
Practice address
503 CENTER ST, ALVA, OK 73717-2213
(580) 302-3917
Mailing address
503 CENTER ST, ALVA, OK 73717-2213
(580) 302-3917
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
1814
OK
Other
Enumeration date
08/29/2022
Last updated
08/29/2022
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