Healthcare Provider Details

I. General information

NPI: 1942709647
Provider Name (Legal Business Name): PETER CHI-WIN LI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 HOSPITAL DR
MOUNTAIN HOME AR
72653-2914
US

IV. Provider business mailing address

3901 PARKWAY CIR
SPRINGDALE AR
72762-6362
US

V. Phone/Fax

Practice location:
  • Phone: 479-587-1700
  • Fax: 479-587-1366
Mailing address:
  • Phone: 479-587-1700
  • Fax: 479-587-1366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0101267747
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101267747
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: