| Doctor Name: | DR. JESSE H. BRADLEY |
| NPI Number: | 1114160389 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.P.M. |
| License Number: | 695 |
| Business Practice Address: | 200 S Rhodes St Suite A West Memphis, AR - 723014212 |
| Business Phone Number: | 8707330888 |
| Business Fax Number: | 8707330889 |
| Mailing Address: | Po Box 1752, WEST MEMPHIS |
| State: | AR |
| Postal Code: | 723031752 |
| Phone Number: | 8707330888 |
| Fax Number: | 8707330889 |
| NPI Enumeration Date: | 04/16/2009 |
| NPI Last Update Date: | 12/02/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 695 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TN |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |