| Doctor Name: | DR. JODY BRADSHAW |
| NPI Number: | 1972722205 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | |
| Business Practice Address: | 7001 Rogers Ave Fort Smith, AR - 729034073 |
| Business Phone Number: | 4792745200 |
| Business Fax Number: | 4792745299 |
| Mailing Address: | Po Box 3528, FORT SMITH |
| State: | AR |
| Postal Code: | 729133528 |
| Phone Number: | 4792742000 |
| Fax Number: | 4792742194 |
| NPI Enumeration Date: | 04/25/2007 |
| NPI Last Update Date: | 08/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AR |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |