Doctor Name: | DR. ROBERT BETHELL |
NPI Number: | 1295124113 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | C-3241 |
Business Practice Address: | 1003 Oakwood Dr Wynne, AR - 723961801 |
Business Phone Number: | 8702389651 |
Business Fax Number: | |
Mailing Address: | 1003 Oakwood Dr, WYNNE |
State: | AR |
Postal Code: | 723961801 |
Phone Number: | 8702389651 |
Fax Number: | |
NPI Enumeration Date: | 01/15/2015 |
NPI Last Update Date: | 01/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | C-3241 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |