Healthcare Provider Details

I. General information

NPI: 1770519670
Provider Name (Legal Business Name): THOMAS R DYKMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3344 N FUTRALL DR
FAYETTEVILLE AR
72703-4057
US

IV. Provider business mailing address

PO BOX 1523
FAYETTEVILLE AR
72702-1523
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-8200
  • Fax: 479-528-7310
Mailing address:
  • Phone: 479-521-8200
  • Fax: 479-582-7310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberC-5278
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: