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General NPI Number Information
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NPI Number | 1598186009
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Entity Type | Organization
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Legal Business Name | WESTERN ARKANSAS PRIMARY CARE
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Dates
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Enumeration Date | 12/31/2013
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 1069 S SHARPE AVE
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City | BOONEVILLE
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State | AR
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Zip | 72927-4683
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Country | US
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Telephone | 479-965-8888
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Fax | 479-965-8889
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Provider Business Mailing Address
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Address Line | 2617 E MAIN ST
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City | CHARLESTON
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State | AR
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Zip | 72933-9637
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Country | US
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Telephone | 479-965-8888
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Fax | 479-965-8889
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LONNIE J PARKER
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Credential | MD
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Telephone | 479-965-8888
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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 | E1887
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License Number State | AR
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