Individual
DR. JONATHAN NATHANIEL BRANTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1201 BROAD ROCK BLVD, SURGICAL SERVICE (112H), RICHMOND, VA 23249-0001
(804) 675-5112
(804) 675-5390
Mailing address
1201 BROAD ROCK BLVD, SURGICAL SERVICE (112H), RICHMOND, VA 23249-0001
(804) 675-5112
(804) 675-5390
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0103000902
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005601878
—
VA
Enumeration date
05/10/2006
Last updated
02/21/2025
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