Provider Demographics
NPI:1194081737
Name:BRICKLEY, JESPER (DO)
Entity type:Individual
Prefix:DR
First Name:JESPER
Middle Name:
Last Name:BRICKLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JESPER
Other - Middle Name:JEROME
Other - Last Name:BRICKLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:185 GRAFTON ROAD
Mailing Address - Street 2:
Mailing Address - City:TOWNSHEND
Mailing Address - State:VT
Mailing Address - Zip Code:05353
Mailing Address - Country:US
Mailing Address - Phone:802-365-7357
Mailing Address - Fax:
Practice Address - Street 1:185 GRAFTON ROAD
Practice Address - Street 2:
Practice Address - City:TOWNSHEND
Practice Address - State:VT
Practice Address - Zip Code:05353
Practice Address - Country:US
Practice Address - Phone:802-365-7357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT032.0110481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine