Individual
BRADLEY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8300 CONSTITUTION AVE NE, ALBUQUERQUE, NM 87110-7624
(505) 291-2700
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2022-0038
NM
363A00000X
Physician Assistant
—
—
Other
Enumeration date
01/22/2021
Last updated
06/13/2022
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