Active NPI
Rene Charles Duffourc III, M.D.
- Psychiatry Physician
- Holiday Island, AR
National Provider Identifier
1720209588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- E-6696
- Practice address
- 1 Park Dr
Suite C
Holiday Island, AR 72631-9216 - Phone
- (479) 363-9174
- Fax
- (479) 363-9175
- NPI assigned
- May 1, 2007
- Last updated
- Mar 12, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | E-6696 | AR | Primary |
| Child & Adolescent Psychiatry Physician | 2084P0804X | E-6696 | AR |
Addresses
Primary practice location
1 Park Dr
Suite C
Holiday Island, AR 72631-9216
Mailing address
PO Box 2580
Springfield, MO 65801-2580
Phone (417) 829-4620
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 185967001 | Medicaid | AR | |
| 431560263 | Other | AR | TRICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-6696 | AR | MD | Child & Adolescent Psychiatry Physician |
Interoperability endpoints
- rduffourc188580@directb.mercy.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363046400000",
"number": "1720209588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2580",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658012580",
"telephone_number": "417-829-4620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 PARK DR",
"address_2": "SUITE C",
"city": "HOLIDAY ISLAND",
"state": "AR",
"postal_code": "726319216",
"telephone_number": "479-363-9174",
"fax_number": "479-363-9175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUFFOURC",
"first_name": "RENE",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-01",
"last_updated": "2013-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "AR",
"license": "E-6696",
"primary": true
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "AR",
"license": "E-6696",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "185967001",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "431560263",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Holiday Island, AR
- Lilly Bickford, COTA/L
- Jill J Broyles, COTA
- Terry William Bushay, D.D.S.
- Sidney Carnes
- Sarah Davis
- Eureka Springs Hospital (Eureka Springs Hospital Home Health and Hospice)
- Eureka Springs Hospital (Eureka Srpings Hospital Home Health and Hospice)
- Freds Stores of Tennessee Inc (Freds Pharmacy 1881)
- Carolyn S Gentry, RN
- Brooke Aubrey Granger, COTA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.