Healthcare Provider Details

I. General information

NPI: 1487954749
Provider Name (Legal Business Name): MR. STEVEN WARREN MCDONALD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 W 10TH ST STE 101
LITTLE ROCK AR
72204-1756
US

IV. Provider business mailing address

5905 FOREST PL
LITTLE ROCK AR
72207-5244
US

V. Phone/Fax

Practice location:
  • Phone: 501-666-8686
  • Fax:
Mailing address:
  • Phone: 501-666-4949
  • Fax: 501-660-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: