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General NPI Number Information
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NPI Number | 1568529295
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Entity Type | Organization
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Legal Business Name | ARKANSAS CENTER FOR ARTHROSCOPY, PA
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 1504 SE 28TH ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-3988
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Country | US
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Telephone | 479-273-1111
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Fax | 479-273-1255
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Provider Business Mailing Address
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Address Line | 1504 SE 28TH ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-3988
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Country | US
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Telephone | 479-273-1111
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Fax | 479-273-1255
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER P DOUGHERTY
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Credential | DO
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Telephone | 479-273-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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