Provider Demographics
NPI:1992093538
Name:BRADLEY, DANIEL EVAN (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EVAN
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10452 SILVERDALE WAY NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9460
Mailing Address - Country:US
Mailing Address - Phone:360-307-7300
Mailing Address - Fax:360-307-7304
Practice Address - Street 1:10452 SILVERDALE WAY NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9460
Practice Address - Country:US
Practice Address - Phone:360-307-7300
Practice Address - Fax:360-307-7304
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116980207Q00000X
CODR.0069721207Q00000X
WAMD60824243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty