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General NPI Number Information
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NPI Number | 1750577821
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Entity Type | Organization
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Legal Business Name | BREAST TREATMENT ASSOCIATES, P.A.
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Dates
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Enumeration Date | 09/21/2007
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Last Update Date | 01/04/2019
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Provider Practice Location Address
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Address Line | 1792 E JOYCE BLVD STE 1
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5255
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Country | US
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Telephone | 479-582-1000
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Fax | 479-582-5724
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Provider Business Mailing Address
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Address Line | 1792 E JOYCE BLVD STE 1
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5255
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Country | US
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Telephone | 479-582-1000
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Fax | 479-582-5724
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. DAWN I ROBERTS
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Credential |
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Telephone | 479-582-1000
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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 | MC1480
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License Number State | AR
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