Individual
MR. JOHN D DEDMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1220 W 42ND AVE, PINE BLUFF, AR 71603-7109
(870) 535-2200
(870) 535-2208
Mailing address
1220 W 42ND AVE, PINE BLUFF, AR 71603-7109
(870) 535-2200
(870) 535-2208
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
C-4927
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102984001
—
AR
01
—
11585000000
QUALCHOICE
AR
01
—
4536898
AETNA
AR
01
—
IM68775
UNITED HEALTHCARE
AR
Enumeration date
06/27/2006
Last updated
04/05/2019
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