Healthcare Provider Details

I. General information

NPI: 1174741375
Provider Name (Legal Business Name): HOT SPRINGS GASTROENTEROLOGY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCY LN STE 307
HOT SPRINGS AR
71913-6440
US

IV. Provider business mailing address

1 MERCY LN STE 307
HOT SPRINGS AR
71913-6440
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-4898
  • Fax: 501-623-0260
Mailing address:
  • Phone: 501-623-4898
  • Fax: 501-623-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMC-0581
License Number StateAR

VIII. Authorized Official

Name: DR. RICHARD W. DUNN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 501-623-4898