Individual
MARK ANTHONY VICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
819 W CARPENTER ST, BENTON, AR 72015-3349
(501) 778-8264
(501) 778-7360
Mailing address
819 W CARPENTER ST, BENTON, AR 72015-3349
(501) 778-8264
(501) 778-7360
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C-7760
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111450000
QUALCHOICE
AR
05
—
116882001
—
AR
01
—
4280873
AETNA
AR
Enumeration date
03/20/2006
Last updated
05/19/2008
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