EDWARD WILLARD BRADSHAW III (NPI# 1235192774) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235192774 |
| Entity Type | Individual |
| Full Name | EDWARD WILLARD BRADSHAW III |
| Credential | PA-C |
| Practice Address |
72 Lake Havasu Ave S Ste 102 Lake Havasu City AZ 86403-0857 |
| Practice Telephone | 9284532211 |
| Practice Fax Number | 9284532213 |
| Mailing Telephone | 9284532211 |
| Mailing Fax Number | 9284532219 |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2020-06-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
5357 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA2576 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 040403 | 05 | |
| FL | 291637100 | 05 | |
| RAILROAD MEDICARE | P00221346 | 01 |
| Street Address |
72 LAKE HAVASU AVE S STE 102 |
| City | LAKE HAVASU CITY |
| State | AZ |
| Zip Code | 86403-0857 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457622763 | Panacea Brain and Spine, LLC | Neurological Surgery | 72 Lake Havasu Ave S Ste 102, Lake Havasu City, AZ 86403-0857 | 2012-01-18 |
| 1457513749 | Chad Edward Hartley | Neurological Surgery | 72 Lake Havasu Ave S Ste 102, Lake Havasu City, AZ 86403-0857 | 2008-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104479039 | Liska's Apothecary Shop, Inc. | Assisted Living Facility | 1840 Mesquite Ave., Ste. E, Lake Havasu City, AZ 86403 | 2019-07-19 |
| 1275033227 | Ayad Costy | Pharmacist | 75 North Lake Havasu City, Lake Havasu City, AZ 86403 | 2018-02-16 |
| 1942727250 | Ideal Health Care, L.L.C. | Prosthetic/Orthotic Supplier | 1675 Mesquite Ave Ste A, Lake Havasu City, AZ 86403 | 2017-08-28 |
| 1063965036 | Cerner Health Connections, Inc | Clinic/Center | 89 Civic Center Blvd, Lake Havasu City, AZ 86403 | 2016-07-26 |
| 1447643358 | Lundin Dental PC | Durable Medical Equipment & Medical Supplies | 1741 Mesquite Avenue Ste B 100, Lake Havasu City, AZ 86403 | 2015-03-17 |
| 1912301425 | Arizona Havasu Bdm Pak LLC | Dentist | 1799 North Kiowa Blvd, Unit 109, Lake Havasu, AZ 86403 | 2014-10-13 |
| 1386047850 | Emily E Vona | Nurse Practitioner | 84 Acoma Blvd N Ste 104, Lake Havasu City, AZ 86403 | 2014-09-29 |
| 1750700589 | Thomas Wennergren | Pharmacist | 25 S Lake Havasu Ave, Lake Havasu City, AZ 86403 | 2014-04-09 |
| 1285997460 | Jamie L Lemire | Pharmacist | 1980 Mcculloch Blvd, Lake Havasu City, AZ 86403 | 2012-06-21 |
| 1053694448 | Goodwill of Northern Arizona | Exclusive Provider Organization | 1990 Mcculloch Blvd North, Lake Havasu City, AZ 86403 | 2011-09-22 |
| Find all providers in zip 86403 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588603542 | Christian L Grandell | Physician Assistant | 2035 Mesquite Ave, #a, Lake Havasu City, AZ 86403-5894 | 2006-06-05 |
| 1104895655 | Margaret B Holmes | Physician Assistant | 1720 Mesquite Ave, Suite 102, Lake Havasu City, AZ 86403-5602 | 2006-03-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760030647 | Blaine Wesley Price | Physician Assistant | 796 W Jardin Dr, Casa Grande, AZ 85122-6162 | 2019-09-03 |
| 1790347292 | James M Goldhardt | Physician Assistant | 1400 S Dobson Rd Ste A200, Mesa, AZ 85202-4707 | 2019-07-03 |
| 1972166858 | Red Heart Surgical Assisting | Physician Assistant | 43643 W Arizona Ave, Maricopa, AZ 85138-5642 | 2019-04-17 |
| 1053898833 | Sportsmedicine Outreach Specialist | Physician Assistant | 13247 N 80th Pl, Scottsdale, AZ 85260-4903 | 2018-07-24 |
| 1912496712 | Hw Surgical Assist, Pllc | Physician Assistant | 4057 E Laurel Ave, Gilbert, AZ 85234 | 2018-05-07 |
| 1346741501 | Coraesthetics Pllc | Physician Assistant | 2008 E Laguna Dr, Tempe, AZ 85282 | 2018-02-23 |
| 1366955155 | Jennifer R Osborne | Physician Assistant | 100 S Eastern Dawn Ave, Tucson, AZ 85748-1708 | 2017-11-15 |
| 1669985198 | Jacki Nichols | Physician Assistant | 5055 N Rock Canyon Rd, Tucson, AZ 85750-6003 | 2017-11-06 |
| 1720597214 | Merieme Khamsi | Physician Assistant | 14674 W Mountain View Blvrd #210, Surprise, AZ 85374 | 2017-09-27 |
| 1801305073 | Panduga Surgical Care, Pllc | Physician Assistant | 4904 S Power Rd Ste 103, Pmb 450, Mesa, AZ 85212-3610 | 2017-09-20 |
| Find all providers with the same taxonomy | ||||
| City | LAKE HAVASU CITY |
| Zip Code | 86403 |
Please comment or provide details below to improve the information on EDWARD WILLARD BRADSHAW III.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.