Melville Douglas Bradley, MD

Individual provider Active NPI General Practice Physician · McAlester, OK

NPI 1487734083 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1487734083
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Physician 208D00000X
License
0101055257 (VA)
Practice address
1 C Tree Rd BLDG 5
McAlester Army Ammunition Plant
McAlester, OK 74501-9002
Phone
(918) 420-6495
Fax
(918) 420-7497
NPI assigned
Oct 17, 2006
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101055257VAMDEmergency Medicine Physician

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 0101055257 VA Yes

Addresses

Primary practice location

1 C Tree Rd BLDG 5
McAlester Army Ammunition Plant
McAlester, OK 74501-9002

Mailing address

1 C Tree Rd BLDG 5
McAlester Army Ammunition Plant
McAlester, OK 74501-9002

Other providers in McAlester, OK

All providers in McAlester, OK · General Practice Physician in Oklahoma

Sources for this page

Verify at the official NPI Registry.