Individual
BRADFORD A GALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
199792-1205
UT
363A00000X
Physician Assistant
199792-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19979210200001
BCBS OF UTAH
UT
01
—
97009604
PALMETTO
UT
Enumeration date
07/16/2006
Last updated
02/24/2012
Update your record
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