Healthcare Provider Details

I. General information

NPI: 1225020852
Provider Name (Legal Business Name): THE DERMATOLOGY CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 CENTRAL AVE STE N
HOT SPRINGS AR
71913-6404
US

IV. Provider business mailing address

3633 CENTRAL AVE STE N
HOT SPRINGS AR
71913-6404
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-6100
  • Fax: 501-623-6187
Mailing address:
  • Phone: 501-623-6100
  • Fax: 501-623-6187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ADAM S STIBICH
Title or Position: OWNER / PROVIDER / PHYSICIAN
Credential: MD
Phone: 501-623-6100