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General NPI Number Information
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NPI Number | 1548558612
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Entity Type | Individual
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Provider Name | PHILIP PAUL PACK III D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2011
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Last Update Date | 07/12/2025
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Provider Practice Location Address
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Address Line | 415 ALLEN ST
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City | BATESVILLE
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State | AR
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Zip | 72501-6958
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Country | US
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Telephone | 870-307-3790
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Fax |
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Provider Business Mailing Address
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Address Line | 925 DENNISON HTS
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City | SOUTHSIDE
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State | AR
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Zip | 72501-8943
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Country | US
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Telephone | 786-519-9572
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 02007472A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | UO3383
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | OS14245
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | E10076
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License Number State | AR
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