Healthcare Provider Details

I. General information

NPI: 1740219997
Provider Name (Legal Business Name): COLON & RECTAL SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 08/22/2020
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: 479-443-9443
  • Fax: 479-443-4895
Mailing address:
  • Phone: 479-443-9443
  • Fax: 479-443-4895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMC-1354
License Number StateAR

VIII. Authorized Official

Name: DR. WILLIAM B NOWLIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 479-443-9443