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Search › Arkansas › 101Y00000X

Theodore Gongola

NPI 1053656108 · on the registry since 2012

Practice

Address
3205 W Main St
Russellville, AR 72801
Phone
(479) 967-4673
Fax
(479) 967-7140
Organisation at this address
Prescriptive Nutrition, Llc
Radiology Consultants Of Northwest Arkansas
Inferred from a shared address, not stated in the registry.
Clinicians at this address
41

Registry record

Primary taxonomy
101Y00000X
101Y00000X
Sex
Male
Record last updated
2012-11-30

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Arkansas