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Organization
UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Active
Organization
UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Active
Other names
AHEC Fayetteville Pediatric Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. B J ROBERTS (CHIEF FINANCIAL OFFICER)
(479) 521-8269
Entity
Organization
Contact information
Practice address
1125 N COLLEGE AVE, FAYETTEVILLE, AR 72703-1908
(479) 521-8269
(479) 443-3903
Mailing address
1125 N COLLEGE AVE, FAYETTEVILLE, AR 72703-1908
(479) 521-8269
(479) 443-3903
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
170583069
—
AR
01
—
56997
AR BCBS
AR
01
—
770033568
AR BREAST CARE
AR
Enumeration date
07/02/2008
Last updated
01/28/2010
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