Provider Demographics
NPI:1306912118
Name:JONES, BRADFORD H (MD)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:H
Last Name:JONES
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 11128
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98411-0128
Mailing Address - Country:US
Mailing Address - Phone:253-272-8148
Mailing Address - Fax:253-404-0506
Practice Address - Street 1:8573 E PRINCESS DR
Practice Address - Street 2:#B215
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7819
Practice Address - Country:US
Practice Address - Phone:480-563-5757
Practice Address - Fax:480-563-5851
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD40262207RG0100X
AZ31077207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ31077OtherAZ LICENSE
AZZ102830OtherMEDICARE PTAN GROUP
AZ761339Medicaid
AZZ102830OtherMEDICARE PTAN GROUP