| NPI | 1245774041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANA BUSH Credentialing Specialist 479-437-3449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease |
| 213E00000X Podiatrist | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2020-05-13 |