Individual
MR. DEANDRE LAVELL TAYBORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
718 ALCOA RD, BENTON, AR 72015-3406
(501) 776-4110
Mailing address
PO BOX 1589, BENTON, AR 72018-1589
(501) 776-4110
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/22/2011
Last updated
04/22/2013
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