Provider Demographics
NPI:1952600132
Name:BLOCK, JOSHUA R (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:R
Last Name:BLOCK
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 1:101 SUN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-9610
Mailing Address - Country:US
Mailing Address - Phone:479-795-0426
Mailing Address - Fax:479-795-0427
Practice Address - Street 1:101 SUN MEADOW DR
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-9610
Practice Address - Country:US
Practice Address - Phone:479-795-0426
Practice Address - Fax:479-795-0427
Is Sole Proprietor?:No
Enumeration Date:2011-03-27
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60148207Q00000X
ARE-15562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine