Provider Demographics
NPI:1386601540
Name:BRADFORD, JOHN C (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21755 BROOKPARK ROAD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44126
Mailing Address - Country:US
Mailing Address - Phone:440-777-6300
Mailing Address - Fax:440-777-2330
Practice Address - Street 1:400 WABASH AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307
Practice Address - Country:US
Practice Address - Phone:330-344-1799
Practice Address - Fax:330-253-8293
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002912207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0800057Medicaid
C01910Medicare UPIN
OH0800057Medicaid