Organization
THE DERMATOLOGY CLINIC PA
Active
Organization
THE DERMATOLOGY CLINIC PA
Active
Parent organization
THE DERMATOLOGY CLINIC PA
Other names
The Dermatology Clinic PA-Malvern Ave Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE DERMATOLOGY CLINIC PA
Authorized official
MR. ADAM S STIBICH MD (OWNER/ PROVIDER/ PHYSICIAN)
(501) 623-6100
Entity
Organization
Contact information
Practice address
1710 MALVERN AVE, HOT SPRINGS, AR 71901-7132
(501) 623-6100
(501) 623-3403
Mailing address
3633 CENTRAL AVE STE N, HOT SPRINGS, AR 71913-6475
(501) 623-6100
(501) 623-3403
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120956002
—
AR
Enumeration date
02/19/2020
Last updated
09/08/2021
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