Individual
KATIE DEFORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
225 E JACKSON AVE, JONESBORO, AR 72401-3119
(870) 972-4100
Mailing address
225 E JACKSON AVE, JONESBORO, AR 72401-3119
(870) 972-4100
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
E4912
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101245807
STATE LICENSE
VA
05
—
1932220902
—
VA
Enumeration date
04/03/2007
Last updated
04/13/2011
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