Individual
DR. MACON SAMUEL BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
153 DOWELL RD, RUSSELL SPRINGS, KY 42642-4579
(270) 866-4141
Mailing address
P.O. BOX 1610, DOWELL RD, RUSSELL SPRINGS, KY 42642
(270) 866-4141
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
03294
KY
207Q00000X
Family Medicine Physician
03294
KY
207QA0401X
Addiction Medicine (Family Medicine) Physician
03294
KY
Other
Enumeration date
07/25/2009
Last updated
08/31/2017
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