Individual
VON PHOMAKAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5111 ROGERS AVE, STE 40M, FORT SMITH, AR 72903-2047
(479) 709-7440
(479) 709-7441
Mailing address
PO BOX 402319, ATLANTA, GA 30384-2319
(479) 709-7399
(479) 709-7053
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E0767
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100075480A
—
OK
05
—
129386003
—
AR
Enumeration date
10/06/2005
Last updated
08/23/2010
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