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General NPI Number Information
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NPI Number | 1386859411
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Entity Type | Organization
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Legal Business Name | LYDIA LANE DWORKIN, M.D. PA
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 402 W GRAND AVE
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City | HOT SPRINGS
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State | AR
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Zip | 71901-5354
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Country | US
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Telephone | 501-624-1204
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Fax | 501-624-6800
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Provider Business Mailing Address
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Address Line | 402 W GRAND AVE
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City | HOT SPRINGS
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State | AR
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Zip | 71901-5354
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Country | US
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Telephone | 501-624-1204
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Fax | 501-624-6800
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. RENATA L. HRDLICKA
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Credential |
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Telephone | 501-624-1204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | E4078
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License Number State | AR
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