Organization
MED79
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER KEITH MCDANIEL MD (CEO)
(501) 804-5628
Entity
Organization
Contact information
Practice address
2304 W 29TH AVE, PINE BLUFF, AR 71603-5005
(501) 804-5628
Mailing address
3805 WINTERS PL, PINE BLUFF, AR 71603-6413
(501) 804-5628
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/28/2023
Last updated
11/28/2023
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