Individual
JEWELL DOUGLAS BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1363 W SPRUCE AVE, WASILLA, AK 99654-5327
(907) 376-2411
Mailing address
PO BOX 870591, WASILLA, AK 99687-0591
(907) 671-3338
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/28/2022
Last updated
09/28/2022
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