Provider Demographics
NPI:1972247211
Name:BRENT V. WITHERINGTON, M.D. P. A.
Entity type:Organization
Organization Name:BRENT V. WITHERINGTON, M.D. P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:V
Authorized Official - Last Name:WITHERINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-680-8963
Mailing Address - Street 1:11701 SOUTHCREST DR
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-9341
Mailing Address - Country:US
Mailing Address - Phone:501-680-8963
Mailing Address - Fax:
Practice Address - Street 1:3103 ALMA HWY
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5027
Practice Address - Country:US
Practice Address - Phone:479-474-4483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-22
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty