Healthcare Provider Details

I. General information

NPI: 1922052398
Provider Name (Legal Business Name): DAVID C KOLB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BAPTIST HEALTH DR SUITE 1100
LITTLE ROCK AR
72205-6321
US

IV. Provider business mailing address

9601 BAPTIST HEALTH DR SUITE 1100
LITTLE ROCK AR
72205-6321
US

V. Phone/Fax

Practice location:
  • Phone: 501-748-3214
  • Fax: 501-227-9151
Mailing address:
  • Phone: 501-748-3214
  • Fax: 501-227-9151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberC-7303
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: