Active NPI
J Douglas Bradley, M.D.
- Family Medicine Physician
- Pueblo, CO
National Provider Identifier
1932249588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 35663
- Practice address
- 4117 N Elizabeth St
Pueblo, CO 81008-2009 - Phone
- (719) 545-0788
- Fax
- (719) 545-0787
- NPI assigned
- Feb 6, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 35663 | CO | Primary |
Addresses
Primary practice location
4117 N Elizabeth St
Pueblo, CO 81008-2009
Mailing address
3190 Breckenridge Dr W
Colorado Springs, CO 80906-4539
Phone (719) 540-5655
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01356633 | Medicaid | CO |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35663 | CO | MD | Family Medicine Physician |
Interoperability endpoints
- j.bradley@3782.securemail.prognocis.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932249588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3190 BRECKENRIDGE DR W",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809064539",
"telephone_number": "719-540-5655",
"fax_number": "719-540-5655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4117 N ELIZABETH ST",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810082009",
"telephone_number": "719-545-0788",
"fax_number": "719-545-0787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "J",
"middle_name": "DOUGLAS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CO",
"license": "35663",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01356633",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.