Provider Demographics
NPI:1215980099
Name:ASHLEY, BRADFORD C (MD)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:C
Last Name:ASHLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-0310
Mailing Address - Country:US
Mailing Address - Phone:503-682-2875
Mailing Address - Fax:
Practice Address - Street 1:27374 SW GRAHAMS FERRY RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-7201
Practice Address - Country:US
Practice Address - Phone:503-682-2875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD196222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150995Medicaid
ORG19893Medicare UPIN
OR150995Medicaid