Healthcare Provider Details

I. General information

NPI: 1649686643
Provider Name (Legal Business Name): ALAN MEASE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 W MARKHAM ST SLOT 16
LITTLE ROCK AR
72205-3866
US

IV. Provider business mailing address

4815 W MARKHAM ST SLOT 16
LITTLE ROCK AR
72205-3866
US

V. Phone/Fax

Practice location:
  • Phone: 501-280-4511
  • Fax: 501-661-2464
Mailing address:
  • Phone: 501-280-4511
  • Fax: 501-661-2464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12121
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: