Provider Demographics
NPI:1821102559
Name:WAWRZYNEK, ROBERT F JR (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
Last Name:WAWRZYNEK
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2918 LOUIS SESSIONS ST
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653
Mailing Address - Country:US
Mailing Address - Phone:870-265-5343
Mailing Address - Fax:870-265-5686
Practice Address - Street 1:2918 LOUIS SESSIONS ST
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653
Practice Address - Country:US
Practice Address - Phone:870-265-5343
Practice Address - Fax:870-265-5686
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA269363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPA-269OtherSTATE LICENSE