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General NPI Number Information
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NPI Number | 1033123195
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Entity Type | Individual
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Provider Name | STEPHEN R. TOOTHAKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 415 RODGERS DR STE A
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City | SEARCY
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State | AR
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Zip | 72143-7434
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Country | US
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Telephone | 501-278-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 415 RODGERS DR STE A
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City | SEARCY
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State | AR
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Zip | 72143-7434
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Country | US
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Telephone | 501-278-3100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 51776
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | TP925
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | E-13285
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License Number State | AR
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