Organization
WILLIAM W. BRADLEY, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM W BRADLEY M.D. (PRESIDENT)
(573) 682-2101
Entity
Organization
Contact information
Practice address
120 N ROLLINS ST, CENTRALIA, MO 65240-1327
(573) 682-2101
(573) 682-2496
Mailing address
120 N ROLLINS ST, CENTRALIA, MO 65240-1327
(573) 682-2101
(573) 682-2496
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200178903
—
MO
Enumeration date
06/22/2010
Last updated
06/22/2010
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