Healthcare Provider Details

I. General information

NPI: 1215135645
Provider Name (Legal Business Name): TERRI BLACKSTOCK, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SAWTOOTH OAK ST
HOT SPRINGS AR
71901-7160
US

IV. Provider business mailing address

124 SAWTOOTH OAK ST
HOT SPRINGS AR
71901-7160
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-7800
  • Fax: 501-623-7866
Mailing address:
  • Phone: 501-623-7800
  • Fax: 501-623-7866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: TERRI BLACKSTOCK
Title or Position: OWNER
Credential: M.D.
Phone: 501-623-7800