Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 31272 | KY |
N | 111NI0900X | Internist | 31272 | KY |
Y | 207RA0401X | Internist - Addiction Medicine | 31272 | KY |
N | 208000000X | Pediatrician | 31272 | KY |
NPI | 1568615847 |
---|---|
Provider Name | Dr. Ronald Clay Bibb JR. |
First Address | Lexington, KY 40514-8321 |
Second Address | Lexington, KY 40504-3706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2008 |
Last Update Date | 12/03/2020 |