Healthcare Provider Details

I. General information

NPI: 1174603435
Provider Name (Legal Business Name): ANGELA STYLES MD DERMATOLOGY & DERMATOPATHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S ROGERS ST
CLARKSVILLE AR
72830-3739
US

IV. Provider business mailing address

201 S ROGERS ST
CLARKSVILLE AR
72830-3739
US

V. Phone/Fax

Practice location:
  • Phone: 479-754-4333
  • Fax: 479-754-1099
Mailing address:
  • Phone: 479-754-4333
  • Fax: 479-754-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberC-8311
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberC-8311
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License NumberC-8311
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberC-8311
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberC-8311
License Number StateAR
# 6
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC-8311
License Number StateAR

VIII. Authorized Official

Name: DR. ANGELA ROSE STYLES
Title or Position: OWNER
Credential: M.D.
Phone: 479-754-4333