Healthcare Provider Details

I. General information

NPI: 1558350868
Provider Name (Legal Business Name): W BRADFORD BIBLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

793 W STATE ST
COLUMBUS OH
43222-1551
US

IV. Provider business mailing address

DEPT L-647
COLUMBUS OH
43260-0001
US

V. Phone/Fax

Practice location:
  • Phone: 614-234-5100
  • Fax:
Mailing address:
  • Phone: 866-287-0568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35060527
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: