Healthcare Provider Details

I. General information

NPI: 1538131909
Provider Name (Legal Business Name): PIETRO PAOLO DE TOGNI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 COLLEGE AVE
CONWAY AR
72034
US

IV. Provider business mailing address

15 WESTIN DRIVE
CONWAY AR
72034
US

V. Phone/Fax

Practice location:
  • Phone: 501-327-2995
  • Fax: 501-327-2331
Mailing address:
  • Phone: 501-327-2995
  • Fax: 501-327-2331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberE0170
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: