Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | E-9125 | AR |
NPI | 1003104498 |
---|---|
Provider Name | Patrick Risch |
First Address | Fayetteville, AR 72701-4152 |
Second Address | Fayetteville, AR 72703-4096 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2011 |
Last Update Date | 16/06/2015 |