Provider Demographics
NPI:1043643943
Name:YOURPERSONALMD.COM INC
Entity Type:Organization
Organization Name:YOURPERSONALMD.COM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:870-424-9763
Mailing Address - Street 1:400 S COLLEGE ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3923
Mailing Address - Country:US
Mailing Address - Phone:870-424-9763
Mailing Address - Fax:870-424-9762
Practice Address - Street 1:400 S COLLEGE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3923
Practice Address - Country:US
Practice Address - Phone:870-424-9763
Practice Address - Fax:870-424-9762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty