Healthcare Provider Details

I. General information

NPI: 1447234760
Provider Name (Legal Business Name): WILLIAM THOMAS MABREY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 BAPTIST HEALTH DR STE 501
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

924 MAIN ST
CONWAY AR
72032-5424
US

V. Phone/Fax

Practice location:
  • Phone: 501-223-8400
  • Fax: 501-223-3713
Mailing address:
  • Phone: 501-327-4444
  • Fax: 501-327-3962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberC6439
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: