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NORTHWEST DERMATOLOGY CLINIC, P.A.

Physicians Dermatology

Provider NPI: 1366490997

Organization Information:
Organization Name:  NORTHWEST DERMATOLOGY CLINIC, P.A.
Organization is not Subpart
Authorized Official:  JAMES R WHARTON  PRESIDENT  479-750-7200

Practice Location:
5100 S THOMPSON ST # 212  SPRINGDALE, AR 72764-6933 US
Tel: 479-750-7200  Fax: 479-750-7202

Business Mailing Address:
5100 S THOMPSON ST # 212  SPRINGDALE, AR 72764-6933 US
Tel: 479-750-7200  Fax: 479-750-7202

NPI Information:
NPI: 1366490997
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N207N00000XPhysicians
Dermatology
ARMC1781
N207ND0101XPhysicians
Dermatology
ARMC1781
Y207ND0900XPhysicians
Dermatology
ARMC1781
N207NS0135XPhysicians
Dermatology
ARMC1781

Other Provider Identifiers:

IssuerNumberStateType
133978002AR05



American Medical Association 2012 taxonomy code information

Code: 207ND0900X

Type:

Classification:



Definition:



MEDICAL JOBS AR - Page 1

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