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General NPI Number Information
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NPI Number | 1528174489
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Entity Type | Individual
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Provider Name | BRADFORD R EGLY DPM
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 04/21/2010
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Provider Practice Location Address
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Address Line | 108 W MAIN ST
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City | DWIGHT
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State | IL
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Zip | 60420
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Country | US
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Telephone | 815-584-9000
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Fax | 815-584-2261
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Provider Business Mailing Address
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Address Line | 108 W MAIN ST
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City | DWIGHT
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State | IL
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Zip | 60420
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Country | US
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Telephone | 815-584-9000
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Fax | 815-584-2261
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016004698
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License Number State | IL
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