Provider Demographics
NPI:1255359931
Name:MEHL, JOHN KURT (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KURT
Last Name:MEHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7001 ROGERS AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4073
Mailing Address - Country:US
Mailing Address - Phone:479-314-4650
Mailing Address - Fax:479-452-9459
Practice Address - Street 1:7001 ROGERS AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4073
Practice Address - Country:US
Practice Address - Phone:479-314-4650
Practice Address - Fax:479-452-9459
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARN-8282207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
060019708OtherRR MEDICARE
AR121610001Medicaid
F29693Medicare UPIN
AR55644Medicare ID - Type Unspecified