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General NPI Number Information
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NPI Number | 1417164559
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Entity Type | Organization
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Legal Business Name | NEUROLOGY AND SLEEP DISORDER CENTER OF SOUTH ARKANSAS
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 300 THOMPSON AVE
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City | EL DORADO
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State | AR
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Zip | 71730-4569
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Country | US
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Telephone | 870-863-7399
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Fax | 870-863-7292
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Provider Business Mailing Address
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Address Line | 300 THOMPSON AVE
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City | EL DORADO
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State | AR
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Zip | 71730-4569
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Country | US
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Telephone | 870-863-7399
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Fax | 870-863-7292
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Authorized Official
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Title or Position | DOCTOR
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Name | SHAILESH C VORA
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Credential | M.D.
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Telephone | 870-863-7399
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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 | R3612
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License Number State | AR
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