Organization
LITTLE ROCK ALLERGY & ASTHMA CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER WAKE (OPERATIONS MANAGER)
(501) 978-7113
Entity
Organization
Contact information
Practice address
18 CORPORATE HILL DR, SUITE 110, LITTLE ROCK, AR 72205-4565
(501) 224-1156
(501) 801-5561
Mailing address
18 CORPORATE HILL DRIVE, SUITE 110, LITTLE ROCK, AR 72205-4565
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
MC0750
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104919002
—
AR
Enumeration date
06/05/2006
Last updated
10/16/2014
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