Healthcare Provider Details

I. General information

NPI: 1851494074
Provider Name (Legal Business Name): NEUROLOGY CLINIC OF CENTRAL ARKANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 KANIS RD STE 700
LITTLE ROCK AR
72211-3727
US

IV. Provider business mailing address

11600 KANIS RD STE 700
LITTLE ROCK AR
72211-3727
US

V. Phone/Fax

Practice location:
  • Phone: 501-312-0070
  • Fax: 501-312-0072
Mailing address:
  • Phone: 501-312-0070
  • Fax: 501-312-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License NumberMC1813
License Number StateAR

VIII. Authorized Official

Name: DR. GARY R GOZA
Title or Position: PRESIDENT
Credential: MD
Phone: 501-312-0070