Healthcare Provider Details

I. General information

NPI: 1124247853
Provider Name (Legal Business Name): DAVID H. WEINGOLD, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4334 E HIGHLAND DR
JONESBORO AR
72401-6621
US

IV. Provider business mailing address

4334 E HIGHLAND DR
JONESBORO AR
72401-6621
US

V. Phone/Fax

Practice location:
  • Phone: 870-802-3376
  • Fax:
Mailing address:
  • Phone: 870-802-3376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHEBA O. CUNNINGHAM
Title or Position: INSURANCE REP.
Credential:
Phone: 870-802-3376