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General NPI Number Information
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NPI Number | 1184951998
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Entity Type | Organization
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Legal Business Name | DONNA BEALLIS D.O. P.A.
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Dates
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Enumeration Date | 11/16/2009
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 153 E MONTE PAINTER DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4002
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Country | US
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Telephone | 479-444-2200
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Fax | 479-444-2390
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Provider Business Mailing Address
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Address Line | PO BOX 11134
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City | FORT SMITH
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State | AR
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Zip | 72917-1134
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Country | US
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Telephone | 479-285-5497
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. DONNA B BEALLIS
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Credential | D.O.
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Telephone | 479-806-0647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | E-5626
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License Number State | AR
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