Healthcare Provider Details

I. General information

NPI: 1841472149
Provider Name (Legal Business Name): CHRISTOPHER L. JOHN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11321 INTERSTATE 30 SUITE 306
LITTLE ROCK AR
72209-7040
US

IV. Provider business mailing address

11321 INTERSTATE 30 SUITE 306
LITTLE ROCK AR
72209-7040
US

V. Phone/Fax

Practice location:
  • Phone: 501-407-0200
  • Fax: 501-407-0220
Mailing address:
  • Phone: 501-407-0200
  • Fax: 501-407-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberE2644
License Number StateAR

VIII. Authorized Official

Name: DR. CHRISTOPHER L JOHN
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 501-407-0200