Mr. Bradley William Buckrop
Primary Podiatric Medicine
3727 46th Avenue Blackhawk Rd Ste 103
Rock Island
, Illinois 61201-7078
Mr. Bradley William Buckrop
Primary Podiatric Medicine
3727 46th Avenue Blackhawk Rd Ste 103
Rock Island
, Illinois 61201-7078
(309) 786-5168
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About
Features
Specialties
- Primary Podiatric Medicine
Languages spoken
- English
Location
First Address
- Mr. Bradley William Buckrop
- 3727 46th Ave Ste 103
- Rock Island, IL
- Zip : 61201-7078
- Fax : (309) 786-5168
- Phone : (309) 788-3668
Second Address
- Mr. Bradley William Buckrop
- 3727 46th Avenue Blackhawk Rd Ste 103
- Rock Island, IL
- Zip : 61201-7078
- Fax : (309) 786-5168
- Phone : (309) 788-3668
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 213EP1101X | Primary Podiatric Medicine | 00545 | IA |
| Y | 213EP1101X | Primary Podiatric Medicine | 016004658 | IL |
National Provider Identifier
| NPI | 1558476739 |
|---|---|
| Provider Name | Mr. Bradley William Buckrop |
| First Address | Rock Island, IL 61201-7078 |
| Second Address | Rock Island, IL 61201-7078 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 20/08/2006 |
| Last Update Date | 04/12/2008 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 00545 | IOWA DEPT OF PUBLIC HLTH (01) | IA |
| 016004658 | (05) | IL |
| 480024844 | JURISDICTION B DME MAC (01) | |
| 8182069 | BCBS (01) | IL |
| BB3472711 | DEA REGISTRATION (01) | |
| IL0101 | JOHN DEERE HEALTH (01) | IL |
| U33388 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.