Most Relevant Information
Provider Data
| NPI Number: | 1003431073 |
| Provider Name: | MACY MARIE BRADBURY |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 10003531A |
Most Important Dates
| Enumeration Date: | 06/15/2020 |
| Last Updated: | 08/29/2023 |
Provider Practice Location
3909 NEW VISION DR
FORT WAYNE
IN
468451725
Practice Location Phone/Fax
| Phone: | 2604696610 |
| Fax: | 2609693065 |
Provider Mailing Location
11109 PARKVIEW PLAZA DR # 117
FORT WAYNE
IN
468451701
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |