=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962468629
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM ROBERT THURLBY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2006
-----------------------------------------------------
Last Update Date | 01/14/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8970 MARKET ST
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72837-9110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-331-3880
-----------------------------------------------------
Fax | 479-331-3788
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8970 MARKET ST
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72837-9110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-331-3880
-----------------------------------------------------
Fax | 479-331-3788
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | C-4419
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------