Healthcare Provider Details

I. General information

NPI: 1548879752
Provider Name (Legal Business Name): NAVDEEP DOGRA MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W 40TH AVE STE 2C
PINE BLUFF AR
71603-6957
US

IV. Provider business mailing address

1801 W 40TH AVE STE 2C
PINE BLUFF AR
71603-6957
US

V. Phone/Fax

Practice location:
  • Phone: 870-663-4849
  • Fax:
Mailing address:
  • Phone: 870-663-4849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: NAVDEEP DOGRA
Title or Position: OWNER/DOCTOR
Credential: MD
Phone: 870-663-4849