Healthcare Provider Details

I. General information

NPI: 1700905296
Provider Name (Legal Business Name): THE DOCTOR'S OFFICE OF MARKED TREE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 NEWSOME DR
MARKED TREE AR
72365-2021
US

IV. Provider business mailing address

PO BOX 616
MARKED TREE AR
72365-0616
US

V. Phone/Fax

Practice location:
  • Phone: 870-358-4355
  • Fax: 870-358-4357
Mailing address:
  • Phone: 870-358-4355
  • Fax: 870-358-4357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR2736
License Number StateAR

VIII. Authorized Official

Name: KIMITAKA SAITO
Title or Position: OWNER PHYSICIAN
Credential: MD
Phone: 870-358-4355