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Organization
DIAGNOSTIC PHYSICIANS OF ARKANSAS, PA
Active
Organization
DIAGNOSTIC PHYSICIANS OF ARKANSAS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD EDWARD EDGERTON (ADMINISTRATOR)
(501) 955-1156
Entity
Organization
Contact information
Practice address
4509 E MCCAIN BLVD, NORTH LITTLE ROCK, AR 72117-2902
(501) 945-8080
(501) 945-5040
Mailing address
4509 E MCCAIN BLVD, NORTH LITTLE ROCK, AR 72117-2902
(501) 945-8080
(501) 945-5040
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
MC2053
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5C147
BLUE CROSS BLUE SHIELD
AR
01
—
CF9997
RAIL ROAD MEDICARE
AR
Enumeration date
08/31/2006
Last updated
09/06/2007
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