Individual
KEVIN L ST. CLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4375 N VANTAGE DR, SUITE 305, FAYETTEVILLE, AR 72703-4982
(479) 443-5100
(479) 443-5117
Mailing address
4375 N VANTAGE DR, SUITE 305, FAYETTEVILLE, AR 72703-4982
(479) 443-5100
(479) 443-5117
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
R4149
AR
207N00000X
Dermatology Physician
Primary
R-4149
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119113001
—
AR
01
—
16085000000
QUALCHOICE
AR
Enumeration date
11/01/2006
Last updated
11/18/2021
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