Individual
GUSTAVIA BRADFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6240 BELCHER OIL CITY RD, BELCHER, LA 71004-7100
(318) 426-6976
Mailing address
6240 BELCHER OIL CITY RD, BELCHER, LA 71004-0134
(318) 426-6976
Taxonomy
Speciality
Code
Description
License number
State
347B00000X
Bus
Primary
005971290
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
86-3750549
—
LA
Enumeration date
05/21/2021
Last updated
05/24/2021
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