Individual provider · Type 1 NPI
Benjamin Daniel Bradford, MD
Facial Plastic Surgery Physician · Stateline, NV
NPI number
1629336128
Active
Practice location
276 Kingsbury Grade # 101
Stateline, NV 89449-9804
Mailing address
PO Box 5910
Stateline, NV 89449-5910
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dermatology Physician | 207N00000X | 22619 (NV) |
| Facial Plastic Surgery Physician | 207YS0123X | A126409 (CA) |
| Facial Plastic Surgery Physician | 207YS0123X | 286986 (NY) |
| Plastic Surgery within the Head & Neck (Otolaryngology) Physician | 207YX0007X | 22619 (NV) |
| Plastic and Reconstructive Surgery Physician | 2086S0122X | 22619 (NV) |
| Facial Plastic Surgery Physician Primary | 207YS0123X | 22619 (NV) |
Facial Plastic Surgery Physician: An otolaryngologist who specializes in facial plastic surgery.
About NPI 1629336128
Benjamin Daniel Bradford, MD's National Provider Identifier is 1629336128, issued on May 3, 2012. The primary taxonomy on file is Facial Plastic Surgery Physician (207YS0123X), and the practice location is in Stateline, NV. The record was last updated on Jan 30, 2023.