Provider Demographics
NPI:1306894803
Name:MAYFIELD, MICHAEL BRADLEY (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRADLEY
Last Name:MAYFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2729 S HIGHWAY 65 82
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653-6136
Mailing Address - Country:US
Mailing Address - Phone:870-265-9364
Mailing Address - Fax:870-265-9366
Practice Address - Street 1:2729 S HIGHWAY 65 82
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-6136
Practice Address - Country:US
Practice Address - Phone:870-265-9364
Practice Address - Fax:870-265-9366
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-8286207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136648001Medicaid
AR136648001Medicaid
ARG46162Medicare UPIN