Organization
OZARK SURGICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CLARA J. PETERS (PRACTICE ADMINISTRATOR)
(479) 521-1484
Entity
Organization
Contact information
Practice address
3017 N BOB YOUNKIN DR, SUITE 101, FAYETTEVILLE, AR 72703-3926
(479) 521-1484
(479) 521-1550
Mailing address
3017 N BOB YOUNKIN DR, SUITE 101, FAYETTEVILLE, AR 72703-3926
(479) 521-1484
(479) 521-1550
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
C7126
AR
208600000X
Surgery Physician
E0751
AR
208600000X
Surgery Physician
E3076
AR
208D00000X
General Practice Physician
N8290
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146704002
—
AR
Enumeration date
10/10/2005
Last updated
11/10/2009
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