Individual
DR. RANDY M ENNEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3312 S 70TH ST, FORT SMITH, AR 72903-5052
(479) 452-7800
(479) 452-9486
Mailing address
3312 S 70TH ST, FORT SMITH, AR 72903-5052
(479) 452-7800
(479) 452-9486
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
N7403
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100177380A
—
OK
05
—
114450001
—
AR
Enumeration date
03/29/2006
Last updated
03/18/2021
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