Organization
TABLE ROCK MOBILE MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY BIGFORD MSN, NP-C (SOLE MEMBER)
(986) 224-8420
Entity
Organization
Contact information
Practice address
3090 E GENTRY WAY STE 210, MERIDIAN, ID 83642-3550
(986) 224-8420
(844) 268-7286
Mailing address
PO BOX 44953, BOISE, ID 83711-0953
(986) 224-8424
(208) 504-2821
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP-1252A
ID
Other
Enumeration date
03/15/2016
Last updated
05/11/2024
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