Individual
CHANSAMONE M PHOMAKAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4700 KELLEY HWY, FORT SMITH, AR 72904-5024
(479) 573-7990
(479) 573-7991
Mailing address
PO BOX 402319, ATLANTA, GA 30384-2319
(479) 709-7399
(709) 709-7053
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-6214
AR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178879001
—
AR
05
—
200232040A
—
OK
Enumeration date
02/14/2007
Last updated
08/27/2010
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