Healthcare Provider Details

I. General information

NPI: 1932359478
Provider Name (Legal Business Name): MR. DALE BRENT ADAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2008
Last Update Date: 09/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2313 ANVIL DR
HARRISON AR
72601-8687
US

IV. Provider business mailing address

2313 ANVIL DR
HARRISON AR
72601-8687
US

V. Phone/Fax

Practice location:
  • Phone: 870-391-2231
  • Fax:
Mailing address:
  • Phone: 870-391-2231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: