Bradshaw, Edward Willard

Bradshaw, Edward Willard is an individual health care provider with primary practice located at 72 Lake Havasu Ave S Ste 102 , Lake Havasu City AZ 86403-0857. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Bradshaw, Edward Willard can be contacted via phone (928) 453-2211.

Contact Information

Primary practice address
72 Lake Havasu Ave S Ste 102 Lake Havasu City AZ 86403-0857
Phone: (928) 453-2211
Fax: (928) 453-2213
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA2576 Florida
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 5357 Arizona

Profile Details

NPI number 1235192774
LBN Legal business name Bradshaw, Edward Willard
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 7th, 2006
Last updated Jun 29th, 2020 - about 4 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 1235192774 NPPES
Arizona MEDICAID 040403
Arizona MEDICAID 291637100
Arizona Other P00221346

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