Mary L. Bradley-Leboeuf, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

22507 Issued in OK

Practice address

1307 Lynn LN
Idabel, OK 74745-6845

Phone

(580) 286-5437

Fax

(580) 286-3955

NPI assigned

Mar 16, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• McCurtain Memorial Medical Management, Inc.

  • Critical Access Hospital
  • Idabel, OK
  • NPI 1063900975
  NPD (past)
• Covenant Medical Group

  • Family Medicine Physician
  • Lubbock, TX
  • NPI 1376598904

  Pediatrics

  NPD (past)
• Covenant Medical Group

  • Rural Health Clinic/Center
  • Abernathy, TX
  • NPI 1538412895
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296604800000",
    "number": "1497724041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1307 LYNN LN",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "747456845",
            "telephone_number": "580-286-5437",
            "fax_number": "580-286-3955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307 LYNN LN",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "747456845",
            "telephone_number": "580-286-5437",
            "fax_number": "580-286-3955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY-LEBOEUF",
        "first_name": "MARY",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-16",
        "last_updated": "2011-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OK",
            "license": "22507",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100187600B",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MED LICENSE",
            "identifier": "22507",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Courtney Billington
• Bio-Medical Applications of Oklahoma, Inc.
• Jamie Bivings, LCSW
• Lea Williamson Black, PHARMACIST
• Amber Clarice Bond, WELLNESS COACH
• Tammy Louise Bray-Wright, C-CHW/PRN
• Brighter Heights Oklahoma, LLC
• Brighter Heights Oklahoma, LLC
• Michael Dewayne Brown Jr., D.O.
• Kelli Brumley

• Pediatrics Physician in Idabel, OK
• Providers in Idabel, OK by specialty
• Pediatrics Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.