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>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1174523120

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
2104 HIGHWAY 367 N  BALD KNOB, AR 72010-9443 US
Tel: 501-724-3110  Fax: 501-724-0140

Contact information for business:
PO BOX 1158  BALD KNOB, AR 72010-1158 US
Tel: 501-724-3110  Fax: 501-724-0140

Registration Information:
NPI: 1174523120
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine

Legacy codes, insurance codes and state license numbers:



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