Healthcare Provider Details

I. General information

NPI: 1114556594
Provider Name (Legal Business Name): SHAUN RENE GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 N COLLEGE AVE
FAYETTEVILLE AR
72703-1908
US

IV. Provider business mailing address

1125 N COLLEGE AVE
FAYETTEVILLE AR
72703-1908
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-8260
  • Fax: 479-444-7820
Mailing address:
  • Phone: 479-521-8260
  • Fax: 479-444-7820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-18701
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2020010224
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: