Healthcare Provider Details

I. General information

NPI: 1740488246
Provider Name (Legal Business Name): BRADLEY L NEWSWANDER, DPM,PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37200 N GANTZEL RD STE 250
SAN TAN VALLEY AZ
85140-7368
US

IV. Provider business mailing address

37200 N GANTZEL RD STE 250
SAN TAN VALLEY AZ
85140-7368
US

V. Phone/Fax

Practice location:
  • Phone: 480-321-8267
  • Fax: 480-840-3458
Mailing address:
  • Phone: 480-321-8267
  • Fax: 480-840-3458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY L NEWSWANDER
Title or Position: OWNER
Credential: DPM
Phone: 480-840-3457