Bradley T Dewall, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

21364 Issued in IA

Practice address

21985 277TH Ave
Le Claire, IA 52753

Phone

(563) 508-6330

NPI assigned

Oct 5, 2006

Last updated

Jun 21, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Danville Polyclinic, LTD

  dba Danville Polyclinic LTD Astc

  • Ambulatory Surgical Clinic/Center
  • Danville, IL
  • NPI 1538101373
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561075200000",
    "number": "1255427597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2543 TECH DR",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527223263",
            "telephone_number": "635-086-3305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21985 277TH AVE",
            "city": "LE CLAIRE",
            "state": "IA",
            "postal_code": "52753",
            "telephone_number": "563-508-6330"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1351 W Central Park Ave Ste 1225",
            "address_purpose": "LOCATION",
            "city": "Davenport",
            "state": "IA",
            "postal_code": "528041889",
            "country_code": "US",
            "telephone_number": "563-421-1585",
            "fax_number": "563-421-1595",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEWALL",
        "first_name": "BRADLEY",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2019-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IA",
            "license": "21364",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK OF IA",
            "identifier": "24004",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian Bennett
• Karen Janice Berg, PT
• Crystal Dawn Buesing, D.C.
• Stephen Walter Byers, DDS
• Deem Therapeutic and Counseling Services PLLC
• Mat Eveleth
• Heather Freyermuth, OTR/L
• Genesis Health System (Genesis Health Group)
• Kathryn Elaine Griffith, ARNP, PMHNP-B.C.
• Guardian Family Care, Inc.

• Specialist in Le Claire, IA
• Providers in Le Claire, IA by specialty
• Specialist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.