Individual
BRADFORD A GALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
100 MARIO CAPECCHI DRIVE, SALT LAKE CITY, UT 84113-1103
(801) 662-5400
(801) 587-6459
Mailing address
PO BOX 413033, SALT LAKE CITY, UT 84141-3033
(801) 213-3900
(801) 587-6459
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
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