Healthcare Provider Details

I. General information

NPI: 1427044353
Provider Name (Legal Business Name): BROOKE A BISBEE DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S. 20TH STREET SUITE B
ROGERS AR
72758-4470
US

IV. Provider business mailing address

200 S. 20TH STREET SUITE B
ROGERS AR
72758-4470
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-9393
  • Fax: 479-636-9341
Mailing address:
  • Phone: 479-636-9393
  • Fax: 479-636-9341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number190
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: