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General NPI Number Information
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NPI Number | 1568615847
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Entity Type | Individual
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Provider Name | RONALD CLAY BIBB JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/30/2008
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 365 WALLER AVE STE 100
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City | LEXINGTON
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State | KY
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Zip | 40504-2924
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Country | US
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Telephone | 859-309-1829
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Fax | 859-303-5337
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Provider Business Mailing Address
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Address Line | 365 WALLER AVE STE 100
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City | LEXINGTON
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State | KY
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Zip | 40504-2924
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Country | US
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Telephone | 859-309-1829
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Fax | 859-303-5337
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 31272
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 31272
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number | 31272
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 31272
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License Number State | KY
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