Healthcare Provider Details

I. General information

NPI: 1710340088
Provider Name (Legal Business Name): GREGORY SKETAS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2016
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4517 PARK AVE
HOT SPRINGS AR
71901
US

IV. Provider business mailing address

1661 AIRPORT RD STE D
HOT SPRINGS AR
71913-8184
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-7900
  • Fax: 501-623-7337
Mailing address:
  • Phone: 501-625-7500
  • Fax: 501-625-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-11871
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: