Healthcare Provider Details

I. General information

NPI: 1184676538
Provider Name (Legal Business Name): DERMATOLOGY GROUP OF ARKANSAS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BAPTIST HEALTH DR. SUITE 690
LITTLE ROCK AR
72205-6328
US

IV. Provider business mailing address

9601 BAPTIST HEALTH DR. SUITE 690
LITTLE ROCK AR
72205-6328
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-8422
  • Fax: 501-537-2399
Mailing address:
  • Phone: 501-227-8422
  • Fax: 501-537-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DINA DAMROW
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 501-227-8422