Healthcare Provider Details

I. General information

NPI: 1750586954
Provider Name (Legal Business Name): DELTA DERMATOLOGY AND SKIN CANCER SPECIALISTS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810B NEWMAN DR
HELENA AR
72342-8950
US

IV. Provider business mailing address

810B NEWMAN DR
HELENA AR
72342-8950
US

V. Phone/Fax

Practice location:
  • Phone: 870-817-0814
  • Fax:
Mailing address:
  • Phone: 870-338-7494
  • Fax: 870-338-8856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSICA PILLOW
Title or Position: SENIOR PARTNER
Credential: MD
Phone: 870-338-7494