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General NPI Number Information
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NPI Number | 1558687525
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Entity Type | Organization
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Legal Business Name | GRACE PATHOLOGY INC
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 11711 HERMITAGE RD SUITE 2
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3718
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Country | US
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Telephone | 501-379-8971
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Fax | 501-379-8976
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Provider Business Mailing Address
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Address Line | 11711 HERMITAGE RD SUITE 2
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3718
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Country | US
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Telephone | 501-379-8971
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Fax | 501-379-8976
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL ANTHONY IRONS
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Credential | M.D.
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Telephone | 501-379-8971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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