Healthcare Provider Details

I. General information

NPI: 1174517460
Provider Name (Legal Business Name): THEODORE W DUENSING DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 ROBINSON AVE
CONWAY AR
72034-4943
US

IV. Provider business mailing address

2513 MCCAIN BLVD # 2-377
NORTH LITTLE ROCK AR
72116-7606
US

V. Phone/Fax

Practice location:
  • Phone: 501-932-3500
  • Fax: 501-932-3520
Mailing address:
  • Phone: 901-737-3071
  • Fax: 901-328-1888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberN7355
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: