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General NPI Number Information
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NPI Number | 1538663729
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Entity Type | Organization
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Legal Business Name | PREMIER GASTROENTEROLOGY ASSOCIATES PLLC
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 10915 N. RODNEY PARHAM SUITE B
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City | LITTLE ROCK
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State | AR
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Zip | 72212
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Country | US
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Telephone | 501-747-2828
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26618
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City | LITTLE ROCK
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State | AR
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Zip | 72221-6601
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Country | US
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Telephone | 501-747-2828
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Fax | 501-747-2868
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Authorized Official
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Title or Position | PRESIDENT
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Name | TERENCE LOAGAN ANGTUACO
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Credential | MD
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Telephone | 501-747-2828
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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 |
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License Number State |
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