Individual
RYAN DAVID MANTOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3215 N NORTH HILLS BLVD., FAYETTEVILLE, AR 72703
(479) 463-7102
(479) 463-5987
Mailing address
PO BOX 550, LOWELL, AR 72745-1900
(479) 473-7775
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
E-13154
AR
207P00000X
Emergency Medicine Physician
MD.37708
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2017
Last updated
04/09/2021
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