Healthcare Provider Details

I. General information

NPI: 1851040307
Provider Name (Legal Business Name): JOHN BRADLEY DIFEBO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S COULTER ST
AMARILLO TX
79106
US

IV. Provider business mailing address

6246 EL COBRE DR
HOUSTON TX
77048-1412
US

V. Phone/Fax

Practice location:
  • Phone: 806-354-1000
  • Fax:
Mailing address:
  • Phone: 713-931-7832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberV6915
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: