Individual
MR. BRADLEY WILLIAM BUCKROP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
3727 46TH AVENUE BLACKHAWK RD, STE 103, ROCK ISLAND, IL 61201-7078
(309) 788-3668
(309) 786-5168
Mailing address
3727 46TH AVE, STE 103, ROCK ISLAND, IL 61201-7078
(309) 788-3668
(309) 786-5168
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
00545
IA
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
016004658
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00545
IOWA DEPT OF PUBLIC HLTH
IA
05
—
016004658
—
IL
01
—
480024844
JURISDICTION B DME MAC
—
01
—
8182069
BCBS
IL
01
—
IL0101
JOHN DEERE HEALTH
IL
Enumeration date
08/20/2006
Last updated
03/07/2023
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