Provider Demographics
NPI:1740254036
Name:NEWSWANDER, BRADLEY L (DPM)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:L
Last Name:NEWSWANDER
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 1:5656 S POWER RD STE 124
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-8489
Mailing Address - Country:US
Mailing Address - Phone:480-840-3457
Mailing Address - Fax:480-840-3458
Practice Address - Street 1:5656 S POWER RD STE 124
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8489
Practice Address - Country:US
Practice Address - Phone:480-840-3457
Practice Address - Fax:480-840-3458
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ575213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ80738Medicare ID - Type Unspecified
U96435Medicare UPIN