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General NPI Number Information
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NPI Number | 1295983237
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Entity Type | Organization
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Legal Business Name | DE QUEEN PEDIATRICS INC
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 04/24/2014
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Provider Practice Location Address
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Address Line | 1357 W COLLIN RAYE DR
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City | DE QUEEN
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State | AR
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Zip | 71832-2946
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Country | US
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Telephone | 870-642-4364
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Fax |
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Provider Business Mailing Address
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Address Line | 1357 W COLLIN RAYE DR
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City | DE QUEEN
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State | AR
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Zip | 71832-2946
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Country | US
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Telephone | 870-642-4364
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | TERRI A DEVLIN
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Credential | M.D.
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Telephone | 870-642-4364
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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 | E-2169
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | E-2169
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License Number State | AR
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