Healthcare Provider Details

I. General information

NPI: 1275995540
Provider Name (Legal Business Name): MITCHELL DAVID ROSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3232 N NORTHHILLS BLVD
FAYETTEVILLE AR
72703-4005
US

IV. Provider business mailing address

3901 PARKWAY CIR
SPRINGDALE AR
72762-6362
US

V. Phone/Fax

Practice location:
  • Phone: 479-587-1700
  • Fax: 479-587-1366
Mailing address:
  • Phone: 479-587-1700
  • Fax: 479-587-1366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberE15454
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: