Individual
GEORGE W DEIMEL IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3317 N WIMBERLY DR, FAYETTEVILLE, AR 72703-4056
(479) 521-2752
(479) 521-4603
Mailing address
PO BOX 1608, FAYETTEVILLE, AR 72702-1608
(479) 521-2752
(479) 521-4603
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
E-8659
AR
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
E-8659
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206486001
—
AR
01
—
5JJ87
BLUE CROSS BLUE SHEILD
AR
Enumeration date
08/03/2009
Last updated
07/12/2021
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