Individual
DR. BERT G MAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2301 S 56TH ST, SUITE 110, FORT SMITH, AR 72903-3755
(479) 452-1581
(479) 452-2148
Mailing address
PO BOX 11880, FORT SMITH, AR 72917-1880
(479) 452-1581
(479) 452-2148
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
E1647
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133303003
—
AR
Enumeration date
10/16/2006
Last updated
08/25/2010
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