Healthcare Provider Details

I. General information

NPI: 1255799656
Provider Name (Legal Business Name): CHRISTOPHER K MOCEK MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 KANIS RD STE 400
LITTLE ROCK AR
72205-6450
US

IV. Provider business mailing address

9101 KANIS RD, STE 400
LITTLE ROCK AR
72205-6456
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-4001
  • Fax: 501-224-4003
Mailing address:
  • Phone: 501-224-4001
  • Fax: 501-224-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateAR

VIII. Authorized Official

Name: DR. CHRISTOPHER K MOCEK
Title or Position: OWNER
Credential: M.D.
Phone: 501-224-4001