Healthcare Provider Details

I. General information

NPI: 1033134218
Provider Name (Legal Business Name): WILLIAM C MCBRYDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E JACKSON AVE
JONESBORO AR
72401-3119
US

IV. Provider business mailing address

709 E COLLEGE ST
BONO AR
72416-9613
US

V. Phone/Fax

Practice location:
  • Phone: 870-972-4145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberC-4737
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: