Provider Demographics
NPI:1124343918
Name:MECUM, DOROTHEE S (MD)
Entity type:Individual
Prefix:MS
First Name:DOROTHEE
Middle Name:S
Last Name:MECUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3425 N FUTRALL DR STE 103
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4820
Mailing Address - Country:US
Mailing Address - Phone:479-332-0700
Mailing Address - Fax:479-332-0701
Practice Address - Street 1:3425 N FUTRALL DR STE 103
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4820
Practice Address - Country:US
Practice Address - Phone:479-332-0700
Practice Address - Fax:479-332-0701
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-83732084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR209873001Medicaid