Basic Information
| Provider Information | |||||||||
| NPI: | 1477591642 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADFORD | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 402 BRADFORD LN | ||||||||
| Address2: | |||||||||
| City: | WAVELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395763204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2284677452 | ||||||||
| FaxNumber: | 7275073618 | ||||||||
| Practice Location | |||||||||
| Address1: | 15200 COMMUNITY RD | ||||||||
| Address2: | |||||||||
| City: | GULFPORT | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395033085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2285757120 | ||||||||
| FaxNumber: | 2285757103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 06162 | MS | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.