Individual provider · Type 1 NPI
Jesse H. Bradley Jr., D.P.M.
Foot & Ankle Surgery Podiatrist · West Memphis, AR
NPI number
1114160389
Active
Practice location
116 W Tyler Ave, Suite B
West Memphis, AR 72301-4221
Fax (870) 733-0889
Mailing address
PO Box 1752
West Memphis, AR 72303-1752
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 80197 (MS) |
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 2007024292 (MO) |
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 695 (TN) |
| Foot & Ankle Surgery Podiatrist Primary | 213ES0103X | 242 (AR) |
Foot & Ankle Surgery Podiatrist: Definition to come...
About NPI 1114160389
Jesse H. Bradley Jr., D.P.M.'s National Provider Identifier is 1114160389, issued on Apr 16, 2009. The primary taxonomy on file is Foot & Ankle Surgery Podiatrist (213ES0103X), and the practice location is in West Memphis, AR. The record was last updated on Jul 22, 2020.