Healthcare Provider Details

I. General information

NPI: 1912962143
Provider Name (Legal Business Name): SETH KLEINBECK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 N MEDICAL DR
STUTTGART AR
72160-3274
US

IV. Provider business mailing address

1609 N MEDICAL DR
STUTTGART AR
72160-3274
US

V. Phone/Fax

Practice location:
  • Phone: 870-674-6117
  • Fax: 870-672-6823
Mailing address:
  • Phone: 870-674-6117
  • Fax: 870-672-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE3392
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: