Healthcare Provider Details

I. General information

NPI: 1285127142
Provider Name (Legal Business Name): PHILLIP J MINGOLA II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N UNIVERSITY AVE
LITTLE ROCK AR
72207-6347
US

IV. Provider business mailing address

PO BOX 55148
LITTLE ROCK AR
72215-5148
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-4116
  • Fax: 501-663-4301
Mailing address:
  • Phone: 501-663-4116
  • Fax: 501-663-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberE-16524
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: