Healthcare Provider Details

I. General information

NPI: 1861931917
Provider Name (Legal Business Name): JOHN BRADLEY BELCHER BS, CPED, LPED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 E BURGESS RD
PENSACOLA FL
32504-7001
US

IV. Provider business mailing address

1243 DUNSTON AVE
BIRMINGHAM AL
35213-2146
US

V. Phone/Fax

Practice location:
  • Phone: 850-503-3246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberPED236
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: