Individual
BRADLEY T DEWALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
21985 277TH AVE, LE CLAIRE, IA 52753
(563) 508-6330
Mailing address
2543 TECH DR, BETTENDORF, IA 52722-3263
(635) 086-3305
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
21364
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24004
WELLMARK OF IA
—
Enumeration date
10/05/2006
Last updated
06/21/2019
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