Thaxton, Dylan Paul

Thaxton, Dylan Paul is an individual health care provider with primary practice located at 2223 Grant St , Malvern AR 72104-4700. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Thaxton, Dylan Paul can be contacted via phone (501) 337-9031.

Contact Information

Primary practice address
2223 Grant St Malvern AR 72104-4700
Phone: (501) 337-9031
Fax: (501) 337-9033
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 2007018509 Missouri
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X E5683 Arkansas

Profile Details

NPI number 1609040849
LBN Legal business name Thaxton, Dylan Paul
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 18th, 2008
Last updated Nov 3rd, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609040849 NPPES
Arkansas MEDICAID 170953001
Arkansas MEDICAID 1609040849
Arkansas MEDICAID 200594090 A

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