Provider Demographics
NPI:1386756724
Name:BRADLEY, GARY W (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:W
Last Name:BRADLEY
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 1:511 BATH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101
Mailing Address - Country:US
Mailing Address - Phone:805-963-9377
Mailing Address - Fax:805-962-2154
Practice Address - Street 1:511 BATH ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101
Practice Address - Country:US
Practice Address - Phone:805-963-9377
Practice Address - Fax:805-962-2154
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26095207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24722Medicare UPIN
CAWA26095HMedicare ID - Type UnspecifiedMEDICARE PPIN NUMBER