Provider Demographics
NPI:1760400477
Name:PASSMORE, ANN K (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:K
Last Name:PASSMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7805 PHOENIX AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5091
Mailing Address - Country:US
Mailing Address - Phone:479-242-2442
Mailing Address - Fax:479-424-4224
Practice Address - Street 1:7805 PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5091
Practice Address - Country:US
Practice Address - Phone:479-242-2442
Practice Address - Fax:479-242-4221
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC-7956208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131621001Medicaid
240005038OtherRR MEDICARE
240005038OtherRR MEDICARE
AR5K464Medicare ID - Type Unspecified