Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Bradley Jack Tishman

Individual provider Family Medicine Physician · NPI 1033783584

Bradley Jack Tishman is a Family Practice in LA Grande, Oregon. Graduated from Lake Erie Col of Osteo Med at Seton Hill Univ in 2021, 5 years ago. Practices with Grande Ronde Hospital Inc, a 96-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
5
Trained at
Lake Erie Col of Osteo Med at Seton Hill Univ
Licensed in
OR
In the registry since
2021
Specialties on file
2
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Practice location Address checks out

506 4th St
LA Grande, OR 97850-1906
Phone: (541) 663-3138
Fax: (541) 975-5120
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • Prisma Health Medical Group Family Medicine Center, Columbia, SC 29203 — (803) 434-6113

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence DO219893 (OR)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1033783584
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMay 19, 2021
Last updated in NPPESAugust 28, 2024
Certification dateAugust 28, 2024
Mailing addressPrisma Health Medical Group Family Medicine Center, 3209 Colonial Drive, Columbia, SC 29203

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolLAKE ERIE COL OF OSTEO MED AT SETON HILL UNIV
Graduated 2021 (5 years in practice)
Group practice Grande Ronde Hospital Inc — 96 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in LA Grande