Healthcare Provider Details

I. General information

NPI: 1871826958
Provider Name (Legal Business Name): TIMOTHY NEAL IRIZARRY P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W WATERMAN ST
DUMAS AR
71639-2139
US

IV. Provider business mailing address

145 W WATERMAN ST
DUMAS AR
71639-2139
US

V. Phone/Fax

Practice location:
  • Phone: 870-382-3080
  • Fax: 870-382-4895
Mailing address:
  • Phone: 870-382-3080
  • Fax: 870-382-4895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-380
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: