Individual
JON EDWIN BRADBURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
929 CENTRAL AVE. NW, EAST GRAND FORKS, MN 56721
(218) 773-6800
(218) 773-6861
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
43109
MN
207Q00000X
Family Medicine Physician
8277
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0123581
MEDICA
—
05
—
11142
—
ND
01
—
26520
BCBS
ND
05
—
420032200
—
MN
01
—
500M4BR
BCBS
MN
01
—
HP31099
HEALTH PARTNERS
—
01
—
NA4571025060
PREFERRED ONE
—
Enumeration date
06/08/2006
Last updated
11/16/2022
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