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General NPI Number Information
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NPI Number | 1992979181
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Entity Type | Organization
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Legal Business Name | DERMOTT FAMILY PRACTICE, INC.
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 105 N FREEMAN ST
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City | DERMOTT
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State | AR
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Zip | 71638-2304
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Country | US
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Telephone | 870-538-3800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 227
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City | DERMOTT
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State | AR
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Zip | 71638-0227
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Country | US
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Telephone | 870-538-3800
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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. CAROLYN E. VOGLER
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Credential | MEDICAL DOCTOR
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Telephone | 870-538-3800
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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 | E-3872
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License Number State | AR
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