Healthcare Provider Details

I. General information

NPI: 1780966937
Provider Name (Legal Business Name): DAPHNE KAREN MACBRUCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2713 S 74TH ST STE 301
FORT SMITH AR
72903-5155
US

IV. Provider business mailing address

2713 S 74TH ST STE 301
FORT SMITH AR
72903-5155
US

V. Phone/Fax

Practice location:
  • Phone: 479-314-4620
  • Fax: 479-314-4630
Mailing address:
  • Phone: 479-314-4620
  • Fax: 479-314-4630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberE-9013
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberE-9013
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: