Healthcare Provider Details

I. General information

NPI: 1174852032
Provider Name (Legal Business Name): HOMER L. FLEISHER III, M.D. PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2009
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 WESTERN AVE SUITE 203
CONWAY AR
72034-4967
US

IV. Provider business mailing address

525 WESTERN AVE SUITE 203
CONWAY AR
72034-4967
US

V. Phone/Fax

Practice location:
  • Phone: 501-327-4828
  • Fax: 501-327-6899
Mailing address:
  • Phone: 501-327-4828
  • Fax: 501-327-6899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberN6929
License Number StateAR

VIII. Authorized Official

Name: SHERRY J ROONEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 501-327-4828