Individual
DR. PENCHALA SWAMY MITTADODLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2708 S RIFE MEDICAL LN, STE 200, ROGERS, AR 72758-1452
(479) 338-3080
(479) 338-3089
Mailing address
2708 S RIFE MEDICAL LN, STE 200, ROGERS, AR 72758-1452
(479) 338-3080
(479) 338-3089
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
E-8192
AR
207RP1001X
Pulmonary Disease Physician
Primary
E-8192
AR
Other
Enumeration date
07/30/2009
Last updated
08/10/2015
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