Individual
CARL ROBERT MAGNESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
102 W DICKSON ST, FAYETTEVILLE, AR 72701-5219
(479) 521-1114
(479) 521-2540
Mailing address
102 W DICKSON ST, FAYETTEVILLE, AR 72701-5219
(479) 521-1114
(479) 521-2540
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
C4954
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106381001
—
AR
01
—
926497965
DRIVERS LICENSE
AR
Enumeration date
10/26/2006
Last updated
05/15/2015
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