Bradley Charles Bandera, MD

Primary specialty

Surgical Oncology PhysicianTaxonomy code 2086X0206X

License

A135798 Issued in CA

Practice address

2200 Santa Monica Blvd
John Wayne Cancer Institute
Santa Monica, CA 90404

Phone

(310) 449-5249

NPI assigned

Aug 19, 2008

Last updated

Nov 29, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543449600000",
    "number": "1427205681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 SANTA MONICA BLVD",
            "address_2": "JOHN WAYNE CANCER INSTITUTE",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "90404",
            "telephone_number": "310-449-5249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 SANTA MONICA BLVD",
            "address_2": "JOHN WAYNE CANCER INSTITUTE",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "90404",
            "telephone_number": "310-449-5249"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3647 J Dewey Gray Cir Ste 200",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309092205",
            "country_code": "US",
            "telephone_number": "706-504-9712",
            "fax_number": "706-504-9703",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANDERA",
        "first_name": "BRADLEY",
        "middle_name": "CHARLES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-19",
        "last_updated": "2018-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "GA",
            "license": "61600",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "61600",
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "CA",
            "license": "A135798",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200619660A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1427205681",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201124040A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amro Balki, M.D.
• Stephen Richard Ball
• Banafsheh Bayati, M.D. Inc.
• Sasha Ember Banaga
• Chloe Banales, LAC
• Joanne Maki Bando, MD
• Michael Bandoma, DPT
• Kelsey Baney, AUD
• Erin Banks, FNP-C
• Andrea Banuelos Mota, MD

• Surgical Oncology Physician in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Surgical Oncology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.