Healthcare Provider Details

I. General information

NPI: 1063460335
Provider Name (Legal Business Name): GEORGE CONNER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 HOLIDAY DR STE 101
FORREST CITY AR
72335-9183
US

IV. Provider business mailing address

902 HOLIDAY DR STE 101
FORREST CITY AR
72335-9183
US

V. Phone/Fax

Practice location:
  • Phone: 870-630-1583
  • Fax: 870-630-1362
Mailing address:
  • Phone: 870-630-1583
  • Fax: 870-630-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR3762
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: