Organization
PARAGOULD PATHOLOGY PA, DAPS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DWIGHT FRANKLIN BOGGS M.D. (PRESIDENT)
(870) 930-3518
Entity
Organization
Contact information
Practice address
900 W KINGSHIGHWAY, PARAGOULD, AR 72450-5942
(870) 930-3518
(870) 930-3569
Mailing address
PO BOX 668, JONESBORO, AR 72403-0668
(870) 930-3518
(870) 930-3569
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5B250
BCBS GROUP PROVIDER #
AR
01
—
P00049060
RAILROAD GROUP PROVIDER #
AR
Enumeration date
07/21/2006
Last updated
08/22/2020
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