Healthcare Provider Details

I. General information

NPI: 1114013349
Provider Name (Legal Business Name): PARAGOULD UROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W KINGSHIGHWAY STE 8
PARAGOULD AR
72450-4197
US

IV. Provider business mailing address

1000 W KINGSHIGHWAY STE 8
PARAGOULD AR
72450-4197
US

V. Phone/Fax

Practice location:
  • Phone: 870-236-3308
  • Fax: 870-236-8530
Mailing address:
  • Phone: 870-236-3308
  • Fax: 870-236-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberE-4246
License Number StateAR

VIII. Authorized Official

Name: DR. DEWEY R SHELLEY
Title or Position: OWNER
Credential: M.D.
Phone: 870-236-3308