Individual
BRADFORD BENNETT JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2224
(817) 321-0404
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3146
(817) 321-0404
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
04-49828
KS
2085R0202X
Diagnostic Radiology Physician
14213246-1235
UT
2085R0202X
Diagnostic Radiology Physician
24502
NH
2085R0202X
Diagnostic Radiology Physician
DR.0073875
CO
2085R0202X
Diagnostic Radiology Physician
MD221169
OR
2085R0202X
Diagnostic Radiology Physician
ME170736
FL
2085R0202X
Diagnostic Radiology Physician
MED-PHYS-LIC-149152
MT
2085R0202X
Diagnostic Radiology Physician
Primary
T9639
TX
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000254978
—
CO
Enumeration date
04/03/2017
Last updated
05/12/2026
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