Healthcare Provider Details

I. General information

NPI: 1649258096
Provider Name (Legal Business Name): KENNETH GENE DOWLESS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4313 W MARKHAM ST
LITTLE ROCK AR
72205-4023
US

IV. Provider business mailing address

4313 W MARKHAM ST
LITTLE ROCK AR
72205-4023
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-9406
  • Fax: 501-686-9276
Mailing address:
  • Phone: 501-686-9406
  • Fax: 501-686-9276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC5047
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: