Healthcare Provider Details

I. General information

NPI: 1144541210
Provider Name (Legal Business Name): JAMES HEAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CLUB LN
CONWAY AR
72034-3681
US

IV. Provider business mailing address

550 CLUB LN
CONWAY AR
72034-3681
US

V. Phone/Fax

Practice location:
  • Phone: 501-329-1510
  • Fax: 501-329-5697
Mailing address:
  • Phone: 501-329-1510
  • Fax: 501-329-5697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number27804
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME122841
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE9769
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: