Organization
BRADLEY W. BUCKROP DPM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY WILLIAM BUCKROP DPM (PODIATRIST/OWNER)
(309) 788-3668
Entity
Organization
Contact information
Practice address
3727 46TH AVE, SUITE 103, ROCK ISLAND, IL 61201-7078
(309) 788-3668
(309) 786-5168
Mailing address
3727 46TH AVE, SUITE 103, ROCK ISLAND, IL 61201-7078
(309) 788-3668
(309) 786-5168
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
01600458
IL
213ES0131X
Foot Surgery Podiatrist
00545
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004658
—
IL
01
—
8182069
BLUE CROSS BLUE SHILD
IL
Enumeration date
12/05/2008
Last updated
03/07/2023
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