Basic Information
| Provider Information | |||||||||
| NPI: | 1942690177 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADFORD | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | CANNON | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4229 N 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850133038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232932387 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2601 E. ROOSEVELT STREET | ||||||||
| Address2: | MARICOPA INTEGRATED HEALTH SYSTEM | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023445011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2015 | ||||||||
| LastUpdateDate: | 01/26/2015 | ||||||||
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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 | 163W00000X | RN140572 | AZ | Y | Nursing Service Providers | Registered Nurse |
No ID Information.