Healthcare Provider Details

I. General information

NPI: 1508394941
Provider Name (Legal Business Name): ASLAN EFENDIZADE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date: 01/03/2018
Reactivation Date: 04/25/2018

III. Provider practice location address

4301 W MARKHAM ST # 556
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

4301 W MARKHAM ST # 783
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 501-296-1095
  • Fax: 501-526-5919
Mailing address:
  • Phone: 501-686-8000
  • Fax: 501-526-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberE-16564
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: