Healthcare Provider Details

I. General information

NPI: 1871664425
Provider Name (Legal Business Name): MICHAEL BRADLEY MAYFIELD MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2729 S HIGHWAY 65 82
LAKE VILLAGE AR
71653-6136
US

IV. Provider business mailing address

2729 S HIGHWAY 65 82
LAKE VILLAGE AR
71653-6136
US

V. Phone/Fax

Practice location:
  • Phone: 870-265-9364
  • Fax: 870-265-9366
Mailing address:
  • Phone: 870-265-9364
  • Fax: 870-265-9366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL BRADLEY MAYFIELD
Title or Position: PRESIDENT
Credential: MD
Phone: 870-265-9364