NPI 1619018793

Robert Gary Mack, BACHELOR

Practitioner Contractor Greenwood, AR

Practice location

Address: 2712 Edgewater Drive, Greenwood, AR 72936
Phone: (479) 414-1190

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence 1002664 (AR)

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Registry record

NPI: 1619018793
Entity type: Individual
Sex (as registered): Male
NPI issued: 9 Feb 2007
Record last updated: 9 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.