Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | R-3828 | AR |
NPI | 1215938998 |
---|---|
Provider Name | Joseph Dale Sarnicki |
First Address | Hampton, AR 71744-8937 |
Second Address | Hampton, AR 71744-8937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 26/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114369003 | (05) | AR |
C68077 | (02) | AR |