Charles Shannon Bradford JR. M.D.

NPI 1811215643 - Internal Medicine - 207R00000X

NPI Details
NPI 1811215643
Gender Male
Enumeration Date 05/04/2010
Last Updated 11/04/2015
Entity Type Individual
Active Over 6 years ago
Practice Location
820 PRUDENTIAL DR STE 304
ATTN: CREDENTIALING DEPARTMENT
JACKSONVILLE FL, 32207-8205, US
Phone (904) 346-3649
Fax (904) 348-5627
Business Location
PO BOX 44004
JACKSONVILLE FL, 32231-4004, US
Phone (904) 376-3707
Fax (912) 350-2156
Toxanomy
Taxonomy Code 207R00000X
License State Georgia
License Number 070347
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According to our database, Dr. Charles Shannon Bradford JR. M.D. NPI is 1811215643, taxonomy code is 207R00000X and license number is 070347, license state is located at Georgia. Charles Shannon Bradford JR. M.D. physically located at 820 Prudential Dr Ste 304, Jacksonville FL, 32207-8205. NPI Number Charles Shannon Bradford JR. M.D. has the Individual type.

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1811215643 NPI number is provided on an as is basis without warranty of any kind. 1811215643 is maintained by the National Plan & Provider Enumeration System. The contents of Charles Shannon Bradford JR. M.D. are for informational purposes only.