Healthcare Provider Details

I. General information

NPI: 1164051801
Provider Name (Legal Business Name): ZACHARY LEE SCHWARTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 04/04/2020
Certification Date: 04/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST # 520
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

1215 COUNTRY MEADOW LN
CEDARVILLE AR
72932-9527
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-6627
  • Fax:
Mailing address:
  • Phone: 479-883-2272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: