Healthcare Provider Details

I. General information

NPI: 1811378896
Provider Name (Legal Business Name): CHRISTOPHER DOVER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N UNIVERSITY AVE STE 200
LITTLE ROCK AR
72207-6360
US

IV. Provider business mailing address

1100 N UNIVERSITY AVE STE 200
LITTLE ROCK AR
72207-6360
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-9300
  • Fax: 501-686-9618
Mailing address:
  • Phone: 501-686-9300
  • Fax: 501-686-9618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8111-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: