Healthcare Provider Details

I. General information

NPI: 1609977271
Provider Name (Legal Business Name): RHONDA M DICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDREN'S WAY # 653
LITTLE ROCK AR
72202-3510
US

IV. Provider business mailing address

1 CHILDREN'S WAY # 653
LITTLE ROCK AR
72202-3510
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-1100
  • Fax:
Mailing address:
  • Phone: 501-364-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberC5976
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: