Individual
STEPHEN PETER BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5375 LAKESHORE BLVD, LAKEPORT, CA 95453-6123
(707) 263-5679
(707) 263-7781
Mailing address
5375 LAKESHORE BLVD, LAKEPORT, CA 95453-6123
(707) 263-5679
(707) 263-7781
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
C41489
CA
208600000X
Surgery Physician
C41489
CA
208D00000X
General Practice Physician
C41489
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C414890
—
CA
Enumeration date
01/30/2006
Last updated
09/12/2022
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