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Physicians General Practice

Provider NPI: 1194767897

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 479-756-1300  Fax: 479-751-7013

Business Mailing Address:
PO BOX 1523  FAYETTEVILLE, AR 72702-1523 US
Tel: 479-571-6038  Fax: 479-442-6523

NPI Information:
NPI: 1194767897
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
General Practice
Family Medicine

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 207Q00000X





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