Individual
DR. BORIS V BOGOMILOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3211 N NORTHHILLS BLVD, SUITE 110, FAYETTEVILLE, AR 72703-4007
(479) 571-4338
(479) 571-4015
Mailing address
3211 N NORTHHILLS BLVD, SUITE 110, FAYETTEVILLE, AR 72703-4007
(479) 571-4338
(479) 571-4015
Taxonomy
Speciality
Code
Description
License number
State
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
E4311
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
156638001
—
AR
05
—
200005240A
—
OK
05
—
207453101
—
MO
01
—
5020011800
QUALCHOICE
AR
01
—
7934401
AETNA
AR
01
—
E4311
STATE LICENSE
AR
Enumeration date
04/17/2006
Last updated
03/07/2023
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