Provider Demographics
NPI:1609942242
Name:CALVIN M BRACY MD PA
Entity Type:Organization
Organization Name:CALVIN M BRACY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-536-7550
Mailing Address - Street 1:1301 WEST 43RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603
Mailing Address - Country:US
Mailing Address - Phone:870-536-7550
Mailing Address - Fax:870-536-1291
Practice Address - Street 1:1301 WEST 43RD AVENUE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603
Practice Address - Country:US
Practice Address - Phone:870-536-7550
Practice Address - Fax:870-536-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4255207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
50578Medicare ID - Type Unspecified
D04381Medicare UPIN