Provider Demographics
NPI:1700779261
Name:BRADFORD, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BUSCH DR # 26601
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-5547
Mailing Address - Country:US
Mailing Address - Phone:904-962-2999
Mailing Address - Fax:
Practice Address - Street 1:15709 TISONS BLUFF RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-0123
Practice Address - Country:US
Practice Address - Phone:904-962-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No347C00000XTransportation ServicesPrivate Vehicle