Healthcare Provider Details

I. General information

NPI: 1891090262
Provider Name (Legal Business Name): PATRICK DAVID ANTOON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 01/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 CHURCH ST
STAMPS AR
71860-2816
US

IV. Provider business mailing address

218 CHURCH ST
STAMPS AR
71860-2816
US

V. Phone/Fax

Practice location:
  • Phone: 870-533-1300
  • Fax: 870-533-1300
Mailing address:
  • Phone: 870-533-1300
  • Fax: 870-533-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-3556
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: