Individual
BRADLEY MICHAEL WITHERELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2104 MASSEY AVE BUILDING 2104, JACKSONVILLE, FL 32228-0148
(904) 270-4303
Mailing address
2104 MASSEY AVE BUILDING 2104, JACKSONVILLE, FL 32228-0148
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
01/08/2018
Last updated
04/15/2025
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