Provider Demographics
NPI:1487734083
Name:BRADLEY, MELVILLE DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:MELVILLE
Middle Name:DOUGLAS
Last Name:BRADLEY
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 1:1 C TREE RD BLDG 5
Mailing Address - Street 2:MCALESTER ARMY AMMUNITION PLANT
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-9002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 C TREE RD BLDG 5
Practice Address - Street 2:MCALESTER ARMY AMMUNITION PLANT
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-9002
Practice Address - Country:US
Practice Address - Phone:918-420-6495
Practice Address - Fax:918-420-7497
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055257208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice