Healthcare Provider Details

I. General information

NPI: 1649241258
Provider Name (Legal Business Name): FREDDY DWIGHT CHRISMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 LILE DR SUITE 600
LITTLE ROCK AR
72205-6225
US

IV. Provider business mailing address

9501 LILE DR SUITE 600
LITTLE ROCK AR
72205-6225
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-7596
  • Fax: 501-227-7787
Mailing address:
  • Phone: 501-227-7596
  • Fax: 501-227-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberE2165
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: