Healthcare Provider Details

I. General information

NPI: 1053171231
Provider Name (Legal Business Name): DILLON R WESTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SCHNEIDER DR
MALVERN AR
72104-4811
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 501-337-4911
  • Fax: 501-337-1051
Mailing address:
  • Phone: 501-337-4911
  • Fax: 501-337-1051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-19856
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-19856
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: