Provider Demographics
NPI:1306085303
Name:BRADLEY, RUSSELL E III
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:E
Last Name:BRADLEY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19803 VENTURA DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-8839
Mailing Address - Country:US
Mailing Address - Phone:513-615-8146
Mailing Address - Fax:513-202-1371
Practice Address - Street 1:19803 VENTURA DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-8839
Practice Address - Country:US
Practice Address - Phone:513-615-8146
Practice Address - Fax:513-202-1371
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications