Healthcare Provider Details

I. General information

NPI: 1194773861
Provider Name (Legal Business Name): THOMAS HUNTER YOUNGBLOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S 6TH PL
LOWELL AR
72745-9704
US

IV. Provider business mailing address

325 S 6TH PL
LOWELL AR
72745-9704
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-9234
  • Fax: 479-717-7557
Mailing address:
  • Phone: 479-636-9234
  • Fax: 479-717-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberR3831
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: