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General NPI Number Information
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NPI Number | 1669289310
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Entity Type | Organization
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Legal Business Name | BRADLEY BIBB MD PLLC
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 2400 S COUNTRY CLUB RD
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City | EL RENO
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State | OK
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Zip | 73036-5801
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Country | US
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Telephone | 405-276-3800
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Fax | 405-276-3912
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Provider Business Mailing Address
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Address Line | 4196 HIGHWAY 62 412 STE A
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City | HARDY
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State | AR
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Zip | 72542-8002
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Country | US
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Telephone | 870-856-1202
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Fax |
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Authorized Official
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Title or Position | DIRECTOR CREDENTIALING
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Name | MONYA YORK
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Credential |
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Telephone | 870-856-1202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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