Provider Demographics
NPI:1700225042
Name:BRADSHAW, SAMUEL LEE (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:LEE
Last Name:BRADSHAW
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 1:6 N POINTE CT STE 202
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3235
Mailing Address - Country:US
Mailing Address - Phone:336-482-2309
Mailing Address - Fax:
Practice Address - Street 1:6 N POINTE CT STE 202
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-3235
Practice Address - Country:US
Practice Address - Phone:336-482-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA161202207Q00000X
NC2016-00390207Q00000X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine