Individual
JARED ANTHONY BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1210 NW 16TH ST, FRUITLAND, ID 83619-2202
(208) 452-8600
Mailing address
5273 S APSLEY PL, BOISE, ID 83709-5179
(208) 871-9025
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
ID-1811
ID
Other
Enumeration date
11/26/2019
Last updated
11/26/2019
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