Provider Demographics
NPI:1063402485
Name:GOINS, DALE E (MD)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:E
Last Name:GOINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1447
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71802-1447
Mailing Address - Country:US
Mailing Address - Phone:870-777-8475
Mailing Address - Fax:870-777-8294
Practice Address - Street 1:302 E 20TH ST
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-8217
Practice Address - Country:US
Practice Address - Phone:870-777-8975
Practice Address - Fax:870-777-8294
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
14169000001OtherQUAL CHOICE
51920OtherBLUE CROSS
710614761OtherTRICARE
080178792OtherRAILROAD MEDICARE
AR102-612-001Medicaid
14169000001OtherQUAL CHOICE
AR102-612-001Medicaid