Healthcare Provider Details

I. General information

NPI: 1114692498
Provider Name (Legal Business Name): TIMOTHY GREGSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 FOREST PL
LITTLE ROCK AR
72207-5244
US

IV. Provider business mailing address

190 AVIATION PLZ STE D
HOT SPRINGS AR
71913-5531
US

V. Phone/Fax

Practice location:
  • Phone: 501-566-1011
  • Fax:
Mailing address:
  • Phone: 501-525-2770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRCP-4056
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: