Arkansas Dermatology Clinic PA
Organization Active NPI Dermatology Physician · Little Rock, AR
NPI 1497713580 · NPPES record last updated Nov 16, 2007
Key facts
- NPI
- 1497713580
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- R2029 (AR)
- Legal business name
- ARKANSAS DERMATOLOGY CLINIC PA
- Practice address
- 500 South University Avenue
Suite 704
Little Rock, AR 72205-5309 - Phone
- (501) 666-5451
- Fax
- (501) 663-3335
- NPI assigned
- May 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Carl Joseph Raque, MD
- Title
- Physician Owner
- Phone
- (501) 666-5451
National Provider Directory
Locations
500 S University Ave
Ste 704
Little Rock, AR 72205
Phone (501) 666-5451
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | R2029 | AR | Yes |
Addresses
Primary practice location
500 South University Avenue
Suite 704
Little Rock, AR 72205-5309
Mailing address
500 South University Avenue
Suite 704
Little Rock, AR 72205-5309
Phone (501) 666-5451
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 54262 | Other | AR | BCBS |
Other providers in Little Rock, AR
- Arkansas Department of Health STD
- Arkansas Department of Health Tuberculosis
- Arkansas Department of Human Services
- Arkansas Dept. of Health and Human Services
- Arkansas Dept. of Health and Human Services
- Arkansas Dermatology PLLC
- Arkansas Dermatopathology PLLC
- Arkansas Diagnostic Center
- Arkansas Diagnostic Center, PA
- Arkansas Digestive Diseases Clinic
All providers in Little Rock, AR · Dermatology Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.