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General NPI Number Information
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NPI Number | 1821059759
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Entity Type | Organization
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Legal Business Name | ARKANSAS NEUROLOGY, INC.
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Dates
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Enumeration Date | 03/30/2006
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 2200 ADA AVE
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City | CONWAY
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State | AR
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Zip | 72034-4985
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Country | US
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Telephone | 501-932-0352
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Fax | 501-932-0354
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Provider Business Mailing Address
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Address Line | 2200 ADA AVE 305
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City | CONWAY
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State | AR
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Zip | 72034-4985
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Country | US
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Telephone | 501-932-0352
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Fax | 501-932-0354
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY E FREYALDENHOVEN
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Credential | MD
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Telephone | 501-932-0352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | E3108
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License Number State | AR
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