Healthcare Provider Details

I. General information

NPI: 1619974599
Provider Name (Legal Business Name): CHRISTOPHER LEIGH JOHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11321 INTERSTATE 30 STE 306
LITTLE ROCK AR
72209-7067
US

IV. Provider business mailing address

11321 INTERSTATE 30 STE 306
LITTLE ROCK AR
72209-7067
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 TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE2644
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberE2644
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberE6244
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: