Provider Demographics
NPI:1568615847
Name:BIBB, RONALD CLAY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:CLAY
Last Name:BIBB
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1618 HARRODSBURG RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3706
Mailing Address - Country:US
Mailing Address - Phone:859-396-2743
Mailing Address - Fax:859-444-5791
Practice Address - Street 1:1618 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3706
Practice Address - Country:US
Practice Address - Phone:859-396-2743
Practice Address - Fax:859-444-5791
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31272207RA0401X, 208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0928415Medicare PIN