Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | E-12208 | AR |
NPI | 1003278144 |
---|---|
Provider Name | Dylan Estes |
First Address | Batesville, AR 72501-7343 |
Second Address | Batesville, AR 72501-7201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2016 |
Last Update Date | 04/09/2019 |