Bradley, Russell

Bradley, Russell is an individual health care provider with primary practice located at 1050 E South Temple , Salt Lake City UT 84102-1507. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medical Services, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Bradley, Russell can be contacted via phone (801) 350-4111.

Contact Information

Primary practice address
1050 E South Temple Salt Lake City UT 84102-1507
Phone: (801) 350-4111
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medical Services 207PE0004X 360067-1205 Utah
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 360067-1205 Utah

Profile Details

NPI number 1376502013
LBN Legal business name Bradley, Russell
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 21st, 2006
Last updated Apr 21st, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376502013 NPPES
Utah MEDICAID D2647

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