Healthcare Provider Details

I. General information

NPI: 1003178666
Provider Name (Legal Business Name): JEREMY J. BRAMWELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 ROSE LN
WICKENBURG AZ
85390
US

IV. Provider business mailing address

523 ROSE LN
WICKENBURG AZ
85390-1448
US

V. Phone/Fax

Practice location:
  • Phone: 928-668-1845
  • Fax: 928-684-7457
Mailing address:
  • Phone: 928-668-1845
  • Fax: 928-684-7457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number006689
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: