Healthcare Provider Details

I. General information

NPI: 1144294299
Provider Name (Legal Business Name): BRUCE D DEYOUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 S WEST END ST
SPRINGDALE AR
72764
US

IV. Provider business mailing address

PO BOX 1523
FAYETTEVILLE AR
72702-1523
US

V. Phone/Fax

Practice location:
  • Phone: 479-750-3630
  • Fax: 479-751-3308
Mailing address:
  • Phone: 479-571-6038
  • Fax: 479-582-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC-8115
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: