Healthcare Provider Details

I. General information

NPI: 1366448730
Provider Name (Legal Business Name): BRADLEY T LEMON D.P.M, F.A.C.F.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 N SHIPLEY ST STE C
SEAFORD DE
19973-2339
US

IV. Provider business mailing address

PO BOX 772
SEAFORD DE
19973-0772
US

V. Phone/Fax

Practice location:
  • Phone: 302-629-3000
  • Fax: 302-629-3080
Mailing address:
  • Phone: 302-629-3000
  • Fax: 302-629-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE10000121
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: