Healthcare Provider Details

I. General information

NPI: 1417954207
Provider Name (Legal Business Name): RICHARD C. PILLSBURY, MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 THOMPSON AVE
EL DORADO AR
71730-4557
US

IV. Provider business mailing address

613 THOMPSON AVE
EL DORADO AR
71730-4557
US

V. Phone/Fax

Practice location:
  • Phone: 870-863-0010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberR3001
License Number StateAR

VIII. Authorized Official

Name: DR. RICHARD CURTIS PILLSBURY
Title or Position: PRESIDENT
Credential: MD
Phone: 870-863-0010