=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366448730
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRADLEY T LEMON D.P.M, F.A.C.F.S
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2005
-----------------------------------------------------
Last Update Date | 02/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 543 N SHIPLEY ST STE C
-----------------------------------------------------
City | SEAFORD
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19973-2339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-629-3000
-----------------------------------------------------
Fax | 302-629-3080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 772
-----------------------------------------------------
City | SEAFORD
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19973-0772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-629-3000
-----------------------------------------------------
Fax | 302-629-3080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | E10000121
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------