| NPI | 1477881092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE H BRADLEY Podiatrist 870-733-0888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AR 242) |
| Enumeration Date | 2009-11-19 |
| Last Update Date | 2020-07-22 |