MEDICARE: DR. RONALD CLAY BIBB JR. 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
1	2083B0002X	Obesity Medicine (Preventive Medicine) Physician	31272	KY
2	207R00000X	Internal Medicine Physician	31272	KY
3	208000000X	Pediatrics Physician	31272	KY
4	207RA0401X	Addiction Medicine (Internal Medicine) Physician	31272	KY

General Provider Information

NPI Number	:	1568615847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD CLAY BIBB JR. M.D.

Provider Business Mailing Address
First Line	:	4010 DUPONT CIR STE 401
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4887
Country	:	US
Telephone Number	:	502-903-5324
Fax Number	:	502-242-7541

Provider Business Practice Location Address
First Line	:	2220 EXECUTIVE DR STE 102
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-4871
Country	:	US
Telephone Number	:	859-396-2743
Fax Number	:	502-242-7541

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2008
Last Update Date	:	05/13/2026

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