Healthcare Provider Details

I. General information

NPI: 1407892805
Provider Name (Legal Business Name): STACY SIRMAR GRIFFIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CORPORATE HILL DR STE 110
LITTLE ROCK AR
72205-4565
US

IV. Provider business mailing address

18 CORPORATE HILL DR STE 110
LITTLE ROCK AR
72205-4565
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-1156
  • Fax: 501-223-2625
Mailing address:
  • Phone: 501-224-1156
  • Fax: 501-223-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberE10498
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: