Basic Information
| Provider Information | |||||||||
| NPI: | 1881135804 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADLEY | ||||||||
| FirstName: | GREG | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 S GARNETT RD STE 112 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741465201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1893535509 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4500 S GARNETT RD STE 112 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741465201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1893535509 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2017 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 6368 | OK | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.