Healthcare Provider Details

I. General information

NPI: 1629456835
Provider Name (Legal Business Name): KEVIN BEDFORD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S 20TH AVE
SAFFORD AZ
85546-4011
US

IV. Provider business mailing address

PO BOX 9261
WICHITA FALLS TX
76308-9261
US

V. Phone/Fax

Practice location:
  • Phone: 702-449-5111
  • Fax:
Mailing address:
  • Phone: 940-764-7230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR9184
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: