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General NPI Number Information
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NPI Number | 1790754133
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Entity Type | Individual
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Provider Name | ALONZO RICHARD BURBA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 08/20/2010
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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 | 501-224-6611
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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 | 501-224-1281
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Fax | 501-224-8633
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | R4463
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License Number State | AR
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