| Doctor Name: | BRADLEY BRADSHAW |
| NPI Number: | 1972747574 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | R5G73 |
| Business Practice Address: | 1904 S Shady Hill Ln Springfield, MO - 658092601 |
| Business Phone Number: | 4178609044 |
| Business Fax Number: | |
| Mailing Address: | 1904 S Shady Hill Ln, SPRINGFIELD |
| State: | MO |
| Postal Code: | 658092601 |
| Phone Number: | 4178609044 |
| Fax Number: | |
| NPI Enumeration Date: | 04/27/2009 |
| NPI Last Update Date: | 04/27/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | R5G73 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |