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General NPI Number Information
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NPI Number | 1053302893
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Entity Type | Individual
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Provider Name | GREGORY S BIENVENU M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2005
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 8907 KANIS RD STE 330
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6451
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Country | US
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Telephone | 501-224-8810
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Fax | 501-224-9076
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Provider Business Mailing Address
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Address Line | PO BOX 17930
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City | LITTLE ROCK
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State | AR
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Zip | 72222-7930
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Country | US
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Telephone | 501-663-0490
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Fax | 501-663-5948
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | R-3940
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License Number State | AR
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