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NPI Code Detail

MEDICARE: PATRICK DAVID ANTOON MD

MEDICARE: PATRICK DAVID ANTOON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianR-3556AR

General Provider Information

NPI Number : 1891090262
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICK DAVID ANTOON MD
Provider Business Mailing Address
First Line : 218 CHURCH ST
Second Line :
City : STAMPS
State : AR
Zip : 71860-2816
Country : US
Telephone Number : 870-533-1300
Fax Number : 870-533-1300
Provider Business Practice Location Address
First Line : 218 CHURCH ST
Second Line :
City : STAMPS
State : AR
Zip : 71860-2816
Country : US
Telephone Number : 870-533-1300
Fax Number : 870-533-1300
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2011
Last Update Date : 01/17/2011

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