Organization
NORTHWEST DERMATOLOGY CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES R WHARTON M.D. (PRESIDENT)
(479) 750-7200
Entity
Organization
Contact information
Practice address
5100 S THOMPSON ST # 212, SPRINGDALE, AR 72764-6933
(479) 750-7200
(479) 750-7202
Mailing address
5100 S THOMPSON ST # 212, SPRINGDALE, AR 72764-6933
(479) 750-7200
(479) 750-7202
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
MC1781
AR
207ND0101X
MOHS-Micrographic Surgery Physician
MC1781
AR
207ND0900X
Dermatopathology Physician
Primary
MC1781
AR
207NS0135X
Procedural Dermatology Physician
MC1781
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133978002
—
AR
Enumeration date
05/05/2006
Last updated
01/06/2010
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