Healthcare Provider Details

I. General information

NPI: 1134363716
Provider Name (Legal Business Name): BRANDON WALSER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT VINCENT CIR SUITE 160
LITTLE ROCK AR
72205-5405
US

IV. Provider business mailing address

1 SAINT VINCENT CIR SUITE 160
LITTLE ROCK AR
72205-5405
US

V. Phone/Fax

Practice location:
  • Phone: 501-661-0037
  • Fax: 501-661-0038
Mailing address:
  • Phone: 501-661-0037
  • Fax: 501-661-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberE7675
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: