Individual
DR. JESSE H. BRADLEY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
116 W TYLER AVE, SUITE B, WEST MEMPHIS, AR 72301-4221
(870) 733-0888
(870) 733-0889
Mailing address
PO BOX 1752, WEST MEMPHIS, AR 72303-1752
(870) 733-0888
(870) 733-0889
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
2007024292
MO
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
242
AR
213ES0103X
Foot & Ankle Surgery Podiatrist
695
TN
213ES0103X
Foot & Ankle Surgery Podiatrist
80197
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180310717
—
AR
05
—
180372748
—
AR
05
—
199945716
—
AR
Enumeration date
04/16/2009
Last updated
07/22/2020
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