Healthcare Provider Details

I. General information

NPI: 1114147691
Provider Name (Legal Business Name): BROOKE A. BISBEE, DPM, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 20TH ST STE. B
ROGERS AR
72758-1104
US

IV. Provider business mailing address

200 S 20TH STREET STE. B
ROGERS AR
72758-1104
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 Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

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