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Individual

MARK STEPHEN BRADLEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1925 ASPEN DR STE 500B, SANTA FE, NM 87505-5495
(505) 466-2575
(505) 466-2575
Mailing address
1925 ASPEN DR STE 500B, SANTA FE, NM 87505-5495
(505) 466-2575
(505) 466-2575

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
2002-0015
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
85327760
NM
01
NM400109
MEDICARE INDIVIDUAL PTAN
Enumeration date
07/05/2006
Last updated
07/26/2009
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