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Individual

DR. BENJAMIN DANIEL BRADFORD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
276 KINGSBURY GRADE # 101, STATELINE, NV 89449-9804
(775) 588-5000
Mailing address
PO BOX 5910, STATELINE, NV 89449-5910
(775) 588-5000

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
22619
NV
207YS0123X
Facial Plastic Surgery Physician
Primary
22619
NV
207YS0123X
Facial Plastic Surgery Physician
286986
NY
207YS0123X
Facial Plastic Surgery Physician
A126409
CA
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
22619
NV
2086S0122X
Plastic and Reconstructive Surgery Physician
22619
NV

Other

Enumeration date
05/03/2012
Last updated
01/30/2023
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