=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174517460
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THEODORE W DUENSING DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2005
-----------------------------------------------------
Last Update Date | 04/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2210 ROBINSON AVE
-----------------------------------------------------
City | CONWAY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72034-4943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-932-3500
-----------------------------------------------------
Fax | 501-932-3520
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2513 MCCAIN BLVD # 2-377
-----------------------------------------------------
City | NORTH LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72116-7606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-737-3071
-----------------------------------------------------
Fax | 901-328-1888
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | N7355
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------