Organization
BRADLEY FOOTCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSE H BRADLEY JR. DPM (PODIATRIST)
(870) 733-0888
Entity
Organization
Contact information
Practice address
116 W TYLER AVE STE 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
Primary
242
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180310717
—
AR
05
—
180372748
—
AR
05
—
199945716
—
AR
Enumeration date
11/19/2009
Last updated
07/22/2020
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