Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 006689 | AZ |
NPI | 1003178666 |
---|---|
Provider Name | Jeremy J. Bramwell |
First Address | Wickenburg, AZ 85390-1448 |
Second Address | Wickenburg, AZ 85390 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2012 |
Last Update Date | 02/03/2020 |