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General NPI Number Information
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NPI Number | 1972247211
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Entity Type | Organization
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Legal Business Name | BRENT V. WITHERINGTON, M.D. P. A.
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Dates
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Enumeration Date | 04/22/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 3103 ALMA HWY
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City | VAN BUREN
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State | AR
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Zip | 72956-5027
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Country | US
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Telephone | 479-474-4483
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Fax |
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Provider Business Mailing Address
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Address Line | 11701 SOUTHCREST DR
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City | FORT SMITH
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State | AR
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Zip | 72916-9341
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Country | US
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Telephone | 501-680-8963
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRENT V. WITHERINGTON
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Credential | M.D.
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Telephone | 501-680-8963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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