Provider Demographics
NPI:1295755064
Name:PARAGOULD PATHOLOGY PA, DAPS PA
Entity type:Organization
Organization Name:PARAGOULD PATHOLOGY PA, DAPS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-930-3518
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-0668
Mailing Address - Country:US
Mailing Address - Phone:870-930-3518
Mailing Address - Fax:870-930-3569
Practice Address - Street 1:900 W KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5942
Practice Address - Country:US
Practice Address - Phone:870-930-3518
Practice Address - Fax:870-930-3569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B250OtherBCBS GROUP PROVIDER #
ARP00049060OtherRAILROAD GROUP PROVIDER #
ARP00049060OtherRAILROAD GROUP PROVIDER #