Healthcare Provider Details

I. General information

NPI: 1285345181
Provider Name (Legal Business Name): RICHARD BRADLEY FLEMING FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7436 E MAIN ST
MESA AZ
85207-8338
US

IV. Provider business mailing address

3571 E AZALEA DR
GILBERT AZ
85298-2212
US

V. Phone/Fax

Practice location:
  • Phone: 480-325-9600
  • Fax:
Mailing address:
  • Phone: 480-527-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number240866
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: