Healthcare Provider Details

I. General information

NPI: 1871609057
Provider Name (Legal Business Name): GREGORY ALTON RHODES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 N BUERKLE ST
STUTTGART AR
72160-3153
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR
LITTLE ROCK AR
72211-4316
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-2093
  • Fax: 501-202-6316
Mailing address:
  • Phone: 501-202-2093
  • Fax: 501-202-6316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR858108
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC003138
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: