Provider Demographics
NPI:1235401746
Name:PRO PHYSICIANS ARKANSAS PA
Entity Type:Organization
Organization Name:PRO PHYSICIANS ARKANSAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRYGGESTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-573-4611
Mailing Address - Street 1:600 E JOHN CARPENTER FWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3990
Mailing Address - Country:US
Mailing Address - Phone:972-573-4611
Mailing Address - Fax:
Practice Address - Street 1:2526 PINNACLE HILLS PKWY
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8939
Practice Address - Country:US
Practice Address - Phone:479-271-8900
Practice Address - Fax:479-271-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC61522085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty