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Physicians General Practice

Provider NPI: 1023070638

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 479-717-6881  Fax: 479-717-6884

Business Mailing Address:
Tel: 479-717-6881  Fax: 479-717-6884

NPI Information:
NPI: 1023070638
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
General Practice

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 208D00000X





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