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General NPI Number Information
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NPI Number | 1942787551
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Entity Type | Organization
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Legal Business Name | DILL MD LTD LLC
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 07/26/2018
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Provider Practice Location Address
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Address Line | 6810 S HAZEL ST
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City | PINE BLUFF
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State | AR
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Zip | 71603-7828
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Country | US
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Telephone | 501-771-4693
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Fax |
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Provider Business Mailing Address
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Address Line | 6671 GAP POINT CIR
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City | SHERWOOD
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State | AR
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Zip | 72120-4052
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Country | US
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Telephone | 501-771-4693
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH DOYNE DILL
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Credential | MD
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Telephone | 870-541-8701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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