Individual
DR. MARY L. BRADLEY-LEBOEUF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1307 LYNN LN, IDABEL, OK 74745-6845
(580) 286-5437
(580) 286-3955
Mailing address
1307 LYNN LN, IDABEL, OK 74745-6845
(580) 286-5437
(580) 286-3955
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
22507
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100187600B
—
OK
01
—
22507
STATE MED LICENSE
OK
Enumeration date
03/16/2006
Last updated
02/02/2011
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