Organization
CENTRAL ARKANSAS EAR NOSE & THROAT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. COLLIE BLEVINS SHAW MD (OWNER PRESIDENT)
(501) 327-3929
Entity
Organization
Contact information
Practice address
2200 ADA AVE, STE 202, CONWAY, AR 72034
(501) 327-3929
(501) 329-3816
Mailing address
2200 ADA AVE, STE 202, CONWAY, AR 72034
(501) 327-3929
(501) 329-3816
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
C7970
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128835002
—
AR
Enumeration date
04/28/2006
Last updated
07/10/2007
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