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NPI Code Detail

MEDICARE: DR. MICHAEL BRADLEY MAYFIELD M.D.

MEDICARE: DR. MICHAEL BRADLEY MAYFIELD M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianC-8286AR
2208600000XSurgery PhysicianC-8286AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306894803
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL BRADLEY MAYFIELD M.D.
Provider Business Mailing Address
First Line : 2729 S HIGHWAY 65 82
Second Line :
City : LAKE VILLAGE
State : AR
Zip : 71653-6136
Country : US
Telephone Number : 870-265-9364
Fax Number : 870-265-9366
Provider Business Practice Location Address
First Line : 2729 S HIGHWAY 65 82
Second Line :
City : LAKE VILLAGE
State : AR
Zip : 71653-6136
Country : US
Telephone Number : 870-265-9364
Fax Number : 870-265-9366
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 11/02/2021

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