Healthcare Provider Details

I. General information

NPI: 1073916383
Provider Name (Legal Business Name): ANTOONMEDICALCLINIC,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 09/30/2014
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: 870-533-1303
Mailing address:
  • Phone: 870-533-1300
  • Fax: 870-533-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberR3556
License Number StateAR

VIII. Authorized Official

Name: DR. PATRICK DAVID ANTOON
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 870-533-1300