Healthcare Provider Details

I. General information

NPI: 1033123195
Provider Name (Legal Business Name): STEPHEN R. TOOTHAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 RODGERS DR STE A
SEARCY AR
72143-7434
US

IV. Provider business mailing address

415 RODGERS DR STE A
SEARCY AR
72143-7434
US

V. Phone/Fax

Practice location:
  • Phone: 501-278-3100
  • Fax:
Mailing address:
  • Phone: 501-278-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number51776
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberTP925
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberE-13285
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: