Individual
DR. LANCE A FADDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
805 W CENTERTON BLVD, CENTERTON, AR 72719-9705
(479) 795-1301
(479) 795-1304
Mailing address
805 W CENTERTON BLVD, CENTERTON, AR 72719-9705
(479) 795-1301
(479) 795-1304
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
E3957
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154233001
—
AR
Enumeration date
04/28/2006
Last updated
12/02/2011
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