EDWARD WILLARD BRADSHAW PA-C NPI 1235192774

NPI Information

NPI: 1235192774
Provider Name: EDWARD WILLARD BRADSHAW, PA-C
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

PECOS Registration: Yes

Address:
72 LAKE HAVASU AVE S STE 102
LAKE HAVASU CITY, AZ
ZIP 86403
Phone: (928) 453-2211
Get Directions

Edward Willard Bradshaw, PA-C is a surgical physician assistant in Lake Havasu City, AZ. Edward Willard Bradshaw, PA-C NPI is 1235192774. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

72 LAKE HAVASU AVE S STE 102
LAKE HAVASU CITY, AZ
ZIP 86403-857
Phone: (928) 453-2211
Fax: (928) 453-2213

The NPI 1235192774 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/7/2006 and was last updated on 6/29/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AS0400X	Physician Assistant	Surgical	PA2576	FLORIDA	No
2	363AS0400X	Physician Assistant	Surgical	5357	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	040403	MEDICAID	ARIZONA
2	291637100	MEDICAID	FLORIDA
3	P00221346	OTHER		RAILROAD MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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