MEDICARE: BRADLEY L NEWSWANDER, DPM,PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP1100X	Podiatric Clinic/Center
2	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician

General Provider Information

NPI Number	:	1740488246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADLEY L NEWSWANDER, DPM,PLC

Provider Business Mailing Address
First Line	:	37200 N GANTZEL RD STE 250
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85140-7368
Country	:	US
Telephone Number	:	480-321-8267
Fax Number	:	480-840-3458

Provider Business Practice Location Address
First Line	:	37200 N GANTZEL RD STE 250
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85140-7368
Country	:	US
Telephone Number	:	480-321-8267
Fax Number	:	480-840-3458

Authorized Official
Title or Position	:	OWNER
Name	:	BRADLEY L NEWSWANDER
Credential	:	DPM
Telephone Number	:	480-840-3457

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	06/23/2020

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