Healthcare Provider Details

I. General information

NPI: 1831595057
Provider Name (Legal Business Name): BRADLEY BIBB MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2014
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 NEWSOME DR
MARKED TREE AR
72365-2021
US

IV. Provider business mailing address

49 HIGHWAY 62 412
ASH FLAT AR
72513-9594
US

V. Phone/Fax

Practice location:
  • Phone: 870-358-4355
  • Fax: 870-994-7488
Mailing address:
  • Phone: 870-994-7301
  • Fax: 870-994-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY BIBB
Title or Position: CEO
Credential: M.D.
Phone: 870-994-7301