Healthcare Provider Details

I. General information

NPI: 1194786111
Provider Name (Legal Business Name): JOSEPH F SHOTTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2037 W MAIN ST
CABOT AR
72023-7479
US

IV. Provider business mailing address

PO BOX 1325
CABOT AR
72023-1325
US

V. Phone/Fax

Practice location:
  • Phone: 501-843-4555
  • Fax: 501-843-7081
Mailing address:
  • Phone: 501-843-4555
  • Fax: 501-843-7081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC7146
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: