Vice, Mark Anthony

Vice, Mark Anthony is an individual health care provider with primary practice located at 819 W Carpenter St , Benton AR 72015-3349. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Vice, Mark Anthony can be contacted via phone (501) 778-8264.

Contact Information

Primary practice address
819 W Carpenter St Benton AR 72015-3349
Phone: (501) 778-8264
Fax: (501) 778-7360
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X C-7760 Arkansas

Profile Details

NPI number 1134188063
LBN Legal business name Vice, Mark Anthony
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 20th, 2006
Last updated May 19th, 2008 - about 18 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 1134188063 NPPES
Arkansas Other 111450000 QUALCHOICE
Arkansas Other 4280873 QUALCHOICE
Arkansas MEDICAID 116882001 QUALCHOICE

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