Basic Information
| Provider Information | |||||||||
| NPI: | 1710298047 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEVENSON | ||||||||
| FirstName: | BRADFORD | ||||||||
| MiddleName: | JASON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5546 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802175546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013976100 | ||||||||
| FaxNumber: | 8013976101 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 HARRISON BLVD | ||||||||
| Address2: | |||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844034303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014753160 | ||||||||
| FaxNumber: | 8014753161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2010 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 208800000X | 9294521-1205 | UT | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.