=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134105042
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC EUGENE BELIN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2005
-----------------------------------------------------
Last Update Date | 11/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 RIORDAN RD
-----------------------------------------------------
City | BELLA VISTA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72714-3516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-876-8550
-----------------------------------------------------
Fax | 479-208-4266
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1651 E STEARNS ST STE 110
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72703-6196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-876-8550
-----------------------------------------------------
Fax | 479-208-4266
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | E-11890
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------