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General NPI Number Information
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NPI Number | 1083269690
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF ARKANSAS AT MONTICELLO
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Dates
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Enumeration Date | 08/09/2019
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 663 UNIVERSITY DRIVE
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City | MONTICELLO
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State | AR
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Zip | 71656
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Country | US
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Telephone | 870-460-1058
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Fax |
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Provider Business Mailing Address
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Address Line | 5050 SPRING VALLEY RD
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City | DALLAS
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State | TX
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Zip | 75244-3995
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/AGENT
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Name | MOUZON BASS III
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Credential |
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Telephone | 972-367-4845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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