Individual
SUSAN WINGO
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1306 W COLLIN RAYE DR, DE QUEEN, AR 71832-2502
(870) 642-7572
(870) 584-4100
Mailing address
1306 W COLLIN RAYE DR, DE QUEEN, AR 71832-2502
(870) 642-7572
(870) 584-4100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E3749
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5M695
AR BCBS
AR
Enumeration date
11/03/2005
Last updated
07/08/2007
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