Individual
DR. MARK G PICKHARDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3302 N NORTHHILLS BLVD, FAYETTEVILLE, AR 72703-4008
(479) 582-3366
(479) 571-6572
Mailing address
PO BOX 1523, FAYETTEVILLE, AR 72702-1523
(479) 571-6038
(479) 582-0222
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
C7319
AR
207VG0400X
Gynecology Physician
Primary
C-7319
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119159001
—
AR
01
—
54558
BLUE
AR
Enumeration date
05/24/2006
Last updated
07/21/2022
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