Individual
JOHN C. BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
9104 MARKET ST, WILMINGTON, NC 28411-7994
(301) 694-3400
(301) 694-3620
Mailing address
PO BOX 18139, RALEIGH, NC 27619-8139
(636) 549-2380
(314) 569-5974
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R118379
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
403621200
—
MD
01
—
KBC1CH
CAREFIRST BCBS
MD
01
—
P00728709
MEDICARE RAILROAD (GRP PTAN CJ8689)
MD
01
—
P00745073
MEDICARE RAILROAD (GRP PTAN DD6120)
MD
01
—
R118379
LICENSE
MD
01
—
S417 0030
CAREFIRST BCBS
DC
Enumeration date
11/29/2006
Last updated
04/30/2011
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