Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | E-9969 | AR |
NPI | 1003227166 |
---|---|
Provider Name | Anthony Meloy |
First Address | Bentonville, AR 72712-8587 |
Second Address | Fayetteville, AR 72703-1908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2014 |
Last Update Date | 06/08/2016 |