Healthcare Provider Details

I. General information

NPI: 1235664608
Provider Name (Legal Business Name): TAMANDA DOUGLAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. TAMANDA CHANZA

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS WAY
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

1 CHILDRENS WAY # 664
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-1100
  • Fax: 501-978-6436
Mailing address:
  • Phone: 501-364-1100
  • Fax: 501-978-6436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberE-19417
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: