Healthcare Provider Details

I. General information

NPI: 1265544373
Provider Name (Legal Business Name): DIAGNOSTIC PHYSICIANS OF ARKANSAS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 E MCCAIN BLVD
NORTH LITTLE ROCK AR
72117-2902
US

IV. Provider business mailing address

4509 E MCCAIN BLVD
NORTH LITTLE ROCK AR
72117-2902
US

V. Phone/Fax

Practice location:
  • Phone: 501-945-8080
  • Fax: 501-945-5040
Mailing address:
  • Phone: 501-945-8080
  • Fax: 501-945-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMC2053
License Number StateAR

VIII. Authorized Official

Name: MR. RONALD EDWARD EDGERTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 501-955-1156