Active NPI
Gary Bradford
- Dietary Manager
- Muskogee, OK
National Provider Identifier
1124327267
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dietary Manager
- Practice address
- 928 N York St
Suite 20
Muskogee, OK 74403-3123 - Phone
- (918) 913-9109
- Fax
- (918) 913-9112
- NPI assigned
- Mar 15, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dietary Manager | 132700000X | Primary |
Addresses
Primary practice location
928 N York St
Suite 20
Muskogee, OK 74403-3123
Mailing address
928 N York St
Suite 20
Muskogee, OK 74403-3123
Phone (918) 913-9109
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 380025 | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1300147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318550400000",
"number": "1124327267",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "928 N YORK ST",
"address_2": "SUITE 20",
"city": "MUSKOGEE",
"state": "OK",
"postal_code": "744033123",
"telephone_number": "918-913-9109",
"fax_number": "918-913-9112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "928 N YORK ST",
"address_2": "SUITE 20",
"city": "MUSKOGEE",
"state": "OK",
"postal_code": "744033123",
"telephone_number": "918-913-9109",
"fax_number": "918-913-9112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADFORD",
"first_name": "GARY",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-03-15",
"last_updated": "2011-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "132700000X",
"taxonomy_group": "",
"desc": "Dietary Manager",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "380025",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Muskogee, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.