Individual
RUSSELL BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1050 E SOUTH TEMPLE, SALT LAKE CITY, UT 84102-1507
(801) 350-4111
Mailing address
144 S 500 E, 2ND FLOOR, SALT LAKE CITY, UT 84102-1907
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
360067-1205
UT
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
360067-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D2647
—
UT
Enumeration date
03/21/2006
Last updated
04/21/2010
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