Provider Demographics
NPI:1023088671
Name:BRONFMAN, RICHARD A (DPM)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:BRONFMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 ALDERSGATE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6611
Mailing Address - Country:US
Mailing Address - Phone:501-224-1501
Mailing Address - Fax:501-376-7065
Practice Address - Street 1:1501 ALDERSGATE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6611
Practice Address - Country:US
Practice Address - Phone:501-224-1501
Practice Address - Fax:501-376-7065
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR85213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
480017644OtherRR MEDICARE
AR56061OtherFIRSTSOURCE PPO
AR104888717Medicaid
AR56061OtherBCBS FEP
AR56061OtherBLUE CROSS BLUE SHIELD
AR56061OtherBLUE ADVANTAGE
AR56061OtherHEALTH ADVANTAGE
480017644OtherRR MEDICARE
AR56061OtherBCBS FEP
AR560617258Medicare Oscar/Certification
AR56061Medicare PIN