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General NPI Number Information
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NPI Number | 1336105063
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Entity Type | Organization
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Legal Business Name | MEDICAL PARK ORTHOPAEDIC CLINIC, P.A.
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 01/06/2009
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Provider Practice Location Address
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Address Line | 501 VIRGINIA DR SUITE C
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City | BATESVILLE
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State | AR
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Zip | 72501-7331
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Country | US
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Telephone | 870-793-2371
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Fax | 870-793-7585
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Provider Business Mailing Address
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Address Line | 501 VIRGINIA DR SUITE C
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City | BATESVILLE
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State | AR
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Zip | 72501-7331
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Country | US
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Telephone | 870-793-2371
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Fax | 870-793-7585
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Authorized Official
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Title or Position | SECRETARY
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Name | JEFFERY DEOIN ANGEL
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Credential | M.D.
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Telephone | 870-793-2371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | AR
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