| Russell D Bradford, MD | |
|
1034 N 500 W, Provo, UT 84604-3380 | |
| (801) 491-6482 | |
| Not Available |
| Full Name | Russell D Bradford |
|---|---|
| Gender | Male |
| Speciality | Pediatrics - Pediatric Infectious Diseases |
| Location | 1034 N 500 W, Provo, Utah |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316093446 | NPI | - | NPPES |
| 009919575 | Medicaid | AL | |
| 009912727 | Medicaid | AL | |
| 009919585 | Medicaid | AL | |
| 051545309 | Other | AL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2080P0208X | Pediatrics - Pediatric Infectious Diseases | 23648 (Alabama) | Primary |
| Entity Name | Ihc Health Services Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1942325154 PECOS PAC ID: 1850209420 Enrollment ID: O20080610000303 |
| Mailing Address | Practice Location Address |
|---|---|
| Russell D Bradford, MD Po Box 27128, Salt Lake City, UT 84127-0128 Ph: (801) 491-6482 | Russell D Bradford, MD 1034 N 500 W, Provo, UT 84604-3380 Ph: (801) 491-6482 |
Dr. Joshua Darrell Fuller, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1675 N Freedom Blvd Ste 3, Provo, UT 84604 Phone: 801-377-8000 | |
Jordan Gaudio, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1034 N 500 W, Provo, UT 84604 Phone: 801-357-1700 | |
Danielle Elise Smith, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1034 N 500 W, Provo, UT 84604 Phone: 801-357-8411 | |
Dr. Chuanchau Jerry Jou, DO Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 1055 N 300 W Ste 311, Provo, UT 84604 Phone: 385-477-6800 Fax: 385-477-6801 | |
Leslie Mark Lang, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1034 N 500 W, Provo, UT 84604 Phone: 801-357-7707 | |
Bradley Wayne Anderson, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1355 N University Ave, #210, Provo, UT 84604 Phone: 801-373-8930 Fax: 801-377-6811 | |
Dr. Matthew Joseph Clayton, D.O. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1675 N Freedom Blvd, Ste 9c, Provo, UT 84604 Phone: 801-377-4800 Fax: 801-377-4041 |