Healthcare Provider Details

I. General information

NPI: 1760783526
Provider Name (Legal Business Name): ARKANSAS DERMATOPATHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BAPTIST HEALTH DR SUITE 690
LITTLE ROCK AR
72205-6328
US

IV. Provider business mailing address

9601 BAPTIST HEALTH DR SUITE 690
LITTLE ROCK AR
72205-6328
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-8422
  • Fax: 501-537-2399
Mailing address:
  • Phone: 501-227-8422
  • Fax: 501-537-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RENIE E BRESSINCK
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 501-227-8422