Healthcare Provider Details

I. General information

NPI: 1639492549
Provider Name (Legal Business Name): DR PAUL W ZELNICK PA.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 HURON LN
LITTLE ROCK AR
72211-1847
US

IV. Provider business mailing address

11400 HURON LN
LITTLE ROCK AR
72211-1847
US

V. Phone/Fax

Practice location:
  • Phone: 501-666-3666
  • Fax: 501-666-2535
Mailing address:
  • Phone: 501-666-3666
  • Fax: 501-666-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR2745
License Number StateAR

VIII. Authorized Official

Name: PAUL W ZELNICK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 501-666-3666