Individual
STACY ROBERT TAIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., F.A.C.C
Contact information
Practice address
2910 JENNY LIND, BLDG #12, FORT SMITH, AR 72901-6735
(479) 785-2555
(479) 785-3555
Mailing address
PO BOX 11016, FORT SMITH, AR 72917-1016
(479) 785-2555
(479) 785-3555
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
N6996
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100199400A
—
OK
05
—
112530001
—
AR
Enumeration date
09/15/2006
Last updated
12/22/2008
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