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Individual
BRADLEY JON WADINGTON
Active
Individual
BRADLEY JON WADINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMP
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
488
NC
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
488
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
488
STATE LICENSE
NC
05
—
790805J
—
NC
Enumeration date
05/31/2006
Last updated
03/11/2008
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