Healthcare Provider Details

I. General information

NPI: 1558781435
Provider Name (Legal Business Name): EDWARD DOOLITTLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 ANNA LN
WEST MEMPHIS AR
72301-6235
US

IV. Provider business mailing address

4001 COMMERCIAL CENTER DR STE 2
MARION AR
72364-9616
US

V. Phone/Fax

Practice location:
  • Phone: 870-514-7406
  • Fax:
Mailing address:
  • Phone: 870-735-4441
  • Fax: 870-735-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: