| NPI | 1801303144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANA BUSH Credentialing Specialist 479-437-3449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 111N00000X Chiropractor |
| 207Q00000X Family Medicine | |
| 207RI0011X Internal Medicine, Interventional Cardiology | |
| 213E00000X Podiatrist | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery | |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2021-08-13 |