Provider Demographics
NPI:1730332008
Name:PREWITT, TAYLOR ARCHIE (M D)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:ARCHIE
Last Name:PREWITT
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8311 MILE TREE DR
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4318
Mailing Address - Country:US
Mailing Address - Phone:479-452-0263
Mailing Address - Fax:479-452-8577
Practice Address - Street 1:8311 MILE TREE DR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4318
Practice Address - Country:US
Practice Address - Phone:479-452-0263
Practice Address - Fax:479-452-8577
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-1926207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease