Individual
BRADLEY LANE JIMERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1747 IMPERIAL BLVD, LAKE CHARLES, LA 70605-5362
(337) 721-7236
(337) 721-7237
Mailing address
1747 IMPERIAL BLVD, LAKE CHARLES, LA 70605-5362
(337) 721-7236
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
322786
LA
390200000X
Student in an Organized Health Care Education/Training Program
PO9593
LA
Other
Enumeration date
06/28/2019
Last updated
07/01/2022
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