Individual
DR. BRENT VAUGHT WITHERINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1188 N SALEM RD STE 6, FAYETTEVILLE, AR 72704-8803
(479) 442-0006
(479) 442-3038
Mailing address
PO BOX 1523, FAYETTEVILLE, AR 72702-1523
(479) 571-6038
(479) 582-0222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-4894
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166741001
—
AR
05
—
200122940A
—
OK
Enumeration date
10/04/2006
Last updated
12/29/2021
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