Basic Information
Provider Information
NPI: 1326149493
EntityType: 2
ReplacementNPI:  
OrganizationName: ARKANSAS OCCUPATIONAL MEDICINE SERVICES PA
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: ARKANSAS OCCUPATIONAL HEALTH
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4001 WAGON WHEEL RD
Address2:  
City: SPRINGDALE
State: AR
PostalCode: 727620137
CountryCode: US
TelephoneNumber: 4797253000
FaxNumber: 4797253098
Practice Location
Address1: 4001 WAGON WHEEL RD
Address2:  
City: SPRINGDALE
State: AR
PostalCode: 727620137
CountryCode: US
TelephoneNumber: 4797253000
FaxNumber: 4797253098
Other Information
ProviderEnumerationDate: 09/25/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: MOFFITT
AuthorizedOfficialFirstName: GARY
AuthorizedOfficialMiddleName: L
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 4797253043
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000XC-5918ARY193400000X SINGLE SPECIALTY GROUPOther Service ProvidersSpecialist 

ID Information
IDTypeStateIssuerDescription
PT191401ARJON LEE, PTOTHER


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