Healthcare Provider Details

I. General information

NPI: 1881468791
Provider Name (Legal Business Name): BROOKE A. BISBEE, DPM, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 CARTER ST
BERRYVILLE AR
72616-4303
US

IV. Provider business mailing address

200 S 20TH ST STE B
ROGERS AR
72758-1100
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-9393
  • Fax:
Mailing address:
  • Phone: 479-636-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: BROOKE BISBEE
Title or Position: OWNER
Credential: DPM
Phone: 479-636-9393