1750342804 NPI number — WILLIAM D DEDMAN MD

Table of content: WILLIAM D DEDMAN MD (NPI 1750342804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750342804 NPI number — WILLIAM D DEDMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEDMAN
Provider First Name:
WILLIAM
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750342804
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 757
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMDEN
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71711-0757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
353 CASH RD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71701-3704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-836-8101
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  C5835 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 271402 . This is a "HEALTHLINK" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 13273000000 . This is a "QUALCHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 4389541 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0122136 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 103666001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 770001401 . This is a "BREASTCARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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