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General NPI Number Information
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NPI Number | 1902832330
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Entity Type | Organization
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Legal Business Name | LITTLE ROCK CANCER CLINIC, P.A.
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 500 S UNIVERSITY AVE SUITE 811
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5302
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Country | US
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Telephone | 501-661-1822
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Fax | 501-666-0266
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Provider Business Mailing Address
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Address Line | 500 S UNIVERSITY AVE STE 606
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5308
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Country | US
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Telephone | 501-661-1822
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Fax | 501-666-0266
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LUIS REYES
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Credential |
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Telephone | 501-661-1822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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