Healthcare Provider Details

I. General information

NPI: 1831297167
Provider Name (Legal Business Name): NORTH ARKANSAS UROLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 W SHERMAN AVE SUITE A
HARRISON AR
72601
US

IV. Provider business mailing address

PO BOX 1140 715 W SHERMAN AVE SUITE A
HARRISON AR
72602
US

V. Phone/Fax

Practice location:
  • Phone: 870-841-2317
  • Fax: 870-741-4090
Mailing address:
  • Phone: 870-841-2317
  • Fax: 870-741-4090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAX ANN FERGUSON
Title or Position: MD OWNER
Credential: MD
Phone: 810-741-2317