Healthcare Provider Details

I. General information

NPI: 1073540084
Provider Name (Legal Business Name): WILLIAM A ISELY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 DETROIT AVE
DANVILLE AR
72833-9607
US

IV. Provider business mailing address

PO BOX 639
DANVILLE AR
72833-0639
US

V. Phone/Fax

Practice location:
  • Phone: 479-495-6270
  • Fax: 479-495-6290
Mailing address:
  • Phone: 479-495-2241
  • Fax: 479-495-6290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberARC6737
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: