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General NPI Number Information
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NPI Number | 1609837459
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Entity Type | Organization
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Legal Business Name | ARKANSAS ALLERGY & ASTHMA CLINIC, P.A.
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 400 SALEM RD SUITE 4
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City | CONWAY
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State | AR
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Zip | 72034-6162
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Country | US
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Telephone | 501-329-0237
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Fax | 501-932-0565
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Provider Business Mailing Address
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Address Line | 400 SALEM RD SUITE 4
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City | CONWAY
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State | AR
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Zip | 72034-6162
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Country | US
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Telephone | 501-329-0237
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Fax | 501-932-0565
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARY PRINCE
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Credential |
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Telephone | 501-329-0237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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