Mangum, Bradley Dee

Mangum, Bradley Dee is an individual health care provider with primary practice located at 559 W Washington St , Burns OR 97720-1441. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Mangum, Bradley Dee can be contacted via phone (541) 573-2074.

Contact Information

Primary practice address
559 W Washington St Burns OR 97720-1441
Phone: (541) 573-2074
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 1573A Idaho

Profile Details

NPI number 1235465147
LBN Legal business name Mangum, Bradley Dee
Credentials FNP-BC, DC
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 27th, 2009
Last updated Dec 3rd, 2020 - about 5 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 1235465147 NPPES
Oregon MEDICAID 500763900

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