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General NPI Number Information
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NPI Number | 1497812903
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSOCIATES OF BENTON
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3 MEDICAL PARK DR
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City | BENTON
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State | AR
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Zip | 72015-3728
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Country | US
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Telephone | 501-778-3361
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Fax | 501-778-3135
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Provider Business Mailing Address
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Address Line | 3 MEDICAL PARK DR
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City | BENTON
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State | AR
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Zip | 72015-3728
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Country | US
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Telephone | 501-778-3361
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Fax | 501-778-3135
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JERRY DIXON
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Credential | MD
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Telephone | 501-778-3361
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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 | E0173
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License Number State | AR
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