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General NPI Number Information
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NPI Number | 1073521175
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Entity Type | Organization
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Legal Business Name | CENTRAL ARKANSAS GASTROENTEROLOGY CLINIC, PA
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 212 NATURAL RESOURCES DR
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City | LITTLE ROCK
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State | AR
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Zip | 72205-1573
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Country | US
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Telephone | 501-664-7200
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Fax | 501-664-7205
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Provider Business Mailing Address
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Address Line | PO BOX 55073
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City | LITTLE ROCK
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State | AR
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Zip | 72215-5073
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Country | US
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Telephone | 501-664-7200
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Fax | 501-664-7205
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEITH EDWARD MORRIS
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Credential | M.D.
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Telephone | 501-664-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | E3487
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License Number State | AR
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