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JESSE H BRADLEY JR, DPM – NPI #1114160389
Surgery, Foot & Ankle

NPI Profile for Dr JESSE H BRADLEY JR in WEST MEMPHIS, AR.

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Contact Information

JESSE H BRADLEY JR, DPM
116 W TYLER AVE
SUITE B
WEST MEMPHIS, AR  72301-4221
 Phone: 870-733-0888
 Fax: 870-733-0889
 Website:
 

Specialty

 Taxonomy Code Specialty Code Provider Type

Surgery, Foot & Ankle

 213ES0103X 48 Podiatry
Indicates primary specialty

NPI Profile & details for JESSE H BRADLEY JR · (Male)

NPI # 1114160389
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 04/16/2009
Last updated 07/22/2020 - About 6 years ago
Sole proprietor 1 Yes
Identifiers
  • AR License # 242
  • MO License # 2007024292
  • MS License # 80197
  • TN License # 695
  • AR Medicaid 180310717
  • AR Medicaid 180372748
  • AR Medicaid 199945716
Hospital affiliation(s)
  • HELENA REGIONAL MEDICAL CENTER - (Acute Care)
    1801 MARTIN LUTHER KING DRIVE
    HELENA, AR 72342
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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