Provider Demographics
NPI:1891090262
Name:ANTOON, PATRICK DAVID (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:DAVID
Last Name:ANTOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:STAMPS
Mailing Address - State:AR
Mailing Address - Zip Code:71860-2816
Mailing Address - Country:US
Mailing Address - Phone:870-533-1300
Mailing Address - Fax:870-533-1300
Practice Address - Street 1:218 CHURCH ST
Practice Address - Street 2:
Practice Address - City:STAMPS
Practice Address - State:AR
Practice Address - Zip Code:71860-2816
Practice Address - Country:US
Practice Address - Phone:870-533-1300
Practice Address - Fax:870-533-1300
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-3556207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine