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General NPI Number Information
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NPI Number | 1487623732
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Entity Type | Organization
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Legal Business Name | ARKANSAS NEURODIAGNOSTIC CENTER, P. A.
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 10/08/2014
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Provider Practice Location Address
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Address Line | 223 SUNNYMEADE DR
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City | LITTLE ROCK
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State | AR
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Zip | 72205-4736
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Country | US
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Telephone | 501-224-6625
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Fax | 501-224-6619
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Provider Business Mailing Address
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Address Line | PO BOX 34113
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City | LITTLE ROCK
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State | AR
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Zip | 72203-4113
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Country | US
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Telephone | 501-224-6625
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Fax | 501-224-6619
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | DR. ALONZO RICHARD BURBA
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Credential | M.D.
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Telephone | 501-224-6625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | R4463
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License Number State | AR
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