Healthcare Provider Details

I. General information

NPI: 1093782815
Provider Name (Legal Business Name): WILLIAM B NOWLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N MARKET AVE SUITE D
FAYETTEVILLE AR
72703-3514
US

IV. Provider business mailing address

3000 N MARKET AVE SUITE D
FAYETTEVILLE AR
72703-3514
US

V. Phone/Fax

Practice location:
  • Phone: 479-966-4801
  • Fax: 479-966-4804
Mailing address:
  • Phone: 479-966-4801
  • Fax: 479-966-4804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberN-7223
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: