Individual
DR. BRADLEY PERSONIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
520 SW RAMSEY AVE, STE 101, GRANTS PASS, OR 97527-5573
(541) 282-6606
(541) 282-6601
Mailing address
520 MEDICAL CENTER DRIVE, STE 200, MEDFORD, OR 97504-4314
(541) 282-6606
(541) 282-6601
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD21214
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
151300
—
OR
Enumeration date
07/21/2005
Last updated
11/15/2011
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