Individual
PHILLIP C STITES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7900 DALLAS STREET, FORT SMITH, AR 72903-5690
(479) 242-6647
(479) 250-0505
Mailing address
7900 DALLAS STREET, FORT SMITH, AR 72903-5690
(479) 242-6647
(479) 250-0505
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
E2778
AR
207ND0101X
MOHS-Micrographic Surgery Physician
E2778
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142944001
—
AR
Enumeration date
10/04/2005
Last updated
02/04/2021
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