Healthcare Provider Details

I. General information

NPI: 1114662277
Provider Name (Legal Business Name): JOHN HOUSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 SPRINGHILL DR
NORTH LITTLE ROCK AR
72117-2922
US

IV. Provider business mailing address

1701 CLUB MANOR DR STE 2B
MAUMELLE AR
72113-7401
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-3000
  • Fax:
Mailing address:
  • Phone: 501-851-7402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-19125
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: