Individual
BRADLEY JASON INGRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1040 DIVISION ST, MAUSTON, WI 53948-1931
(608) 847-5000
Mailing address
1040 DIVISION ST, MAUSTON, WI 53948-1931
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1073
WI
Other
Enumeration date
09/30/2005
Last updated
07/08/2007
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