Individual
JAMES J BRANTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2828 E MILLENNIUM PL, SUITE 2, FAYETTEVILLE, AR 72703-6514
(479) 582-1199
(479) 582-1194
Mailing address
PO BOX 8728, FAYETTEVILLE, AR 72703-0013
(479) 582-1199
(479) 582-1194
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
152
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11443421
CAQH PROVIDER NUMBER
AR
01
—
152
STATE PODIATRY LICENSE
AR
Enumeration date
06/15/2005
Last updated
05/05/2016
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