Healthcare Provider Details

I. General information

NPI: 1306307657
Provider Name (Legal Business Name): JOHN DAVID BRIDGFORTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 COLLEGE AVE STE 100
CONWAY AR
72034-6297
US

IV. Provider business mailing address

PO BOX 9662
CONWAY AR
72033-9662
US

V. Phone/Fax

Practice location:
  • Phone: 501-513-5385
  • Fax: 501-513-5257
Mailing address:
  • Phone: 501-852-1363
  • Fax: 501-852-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-15296
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: