Healthcare Provider Details

I. General information

NPI: 1740257500
Provider Name (Legal Business Name): CAMPBELL KEMP SKOKOS SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S UNIVERSITY STE 414
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

500 S UNIVERSITY STE 414
LITTLE ROCK AR
72205
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-4131
  • Fax: 501-664-9470
Mailing address:
  • Phone: 501-664-4131
  • Fax: 501-664-9470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC5234
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: