Provider Demographics
NPI:1053351221
Name:BRADBURY, MARK F (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:F
Last Name:BRADBURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 CLOVER ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1132
Mailing Address - Country:US
Mailing Address - Phone:541-274-2888
Mailing Address - Fax:541-884-1628
Practice Address - Street 1:2604 CLOVER ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1132
Practice Address - Country:US
Practice Address - Phone:541-274-2888
Practice Address - Fax:541-884-1628
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20477208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130277Medicaid
ORG34252Medicare UPIN
OR130277Medicaid