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Individual

BRADFORD R EGLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DPM

Contact information

Practice address
108 W MAIN ST, DWIGHT, IL 60420
(815) 584-9000
(815) 584-2261
Mailing address
108 W MAIN ST, DWIGHT, IL 60420
(815) 584-9000
(815) 584-2261

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016004698
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
016004698
IL
01
051005617
BCBS AL
AL
01
051005618
BCBS AL
AL
01
051005619
BCBS AL
AL
01
051538406
BCBS AL
AL
01
051548831
BCBS AL
AL
01
059202011
BCBS AL
AL
01
65410
BCBS FLORIDA
FL
01
P00463492
RAILROAD MEDICARE
AL
Enumeration date
08/22/2006
Last updated
04/21/2010
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