Healthcare Provider Details

I. General information

NPI: 1932194974
Provider Name (Legal Business Name): RUSSELL ERIC HATLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S TIMBERLANE DR
EL DORADO AR
71730-6990
US

IV. Provider business mailing address

600 S TIMBERLANE DR
EL DORADO AR
71730-6990
US

V. Phone/Fax

Practice location:
  • Phone: 870-862-2400
  • Fax: 870-862-1891
Mailing address:
  • Phone: 870-862-2400
  • Fax: 870-862-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE1409
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: