Healthcare Provider Details

I. General information

NPI: 1285867945
Provider Name (Legal Business Name): DELTA SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 HIGHWAY 65 S
DUMAS AR
71639-3006
US

IV. Provider business mailing address

105 CARLTON DR
DUMAS AR
71639-2836
US

V. Phone/Fax

Practice location:
  • Phone: 870-382-4303
  • Fax:
Mailing address:
  • Phone: 870-382-1680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER K.H. GO
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 870-382-1680