Provider Demographics
NPI:1538197587
Name:WILLIAMS, BRADLEY DAVID (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:DAVID
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 CROSSINGS DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7101
Mailing Address - Country:US
Mailing Address - Phone:928-778-9250
Mailing Address - Fax:928-778-2306
Practice Address - Street 1:3655 CROSSINGS DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7101
Practice Address - Country:US
Practice Address - Phone:928-778-9250
Practice Address - Fax:928-778-2306
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35254207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ099069Medicaid
AZA93010Medicare UPIN
AZZ154200Medicare PIN
AZZ189152Medicare PIN