Healthcare Provider Details

I. General information

NPI: 1265675466
Provider Name (Legal Business Name): DRS BUDHRAJA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11321 INTERSTATE 30 STE 200
LITTLE ROCK AR
72209-7066
US

IV. Provider business mailing address

11321 INTERSTATE 30 STE 200
LITTLE ROCK AR
72209-7066
US

V. Phone/Fax

Practice location:
  • Phone: 501-455-7009
  • Fax: 501-455-7026
Mailing address:
  • Phone: 501-455-7009
  • Fax: 501-455-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberR3862
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberR3893
License Number StateAR

VIII. Authorized Official

Name: DR. MADHU SUDAN BUDHRAJA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 501-455-7009