Organization
ARKANSAS DERMATOLOGY CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL JOSEPH RAQUE MD (PHYSICIAN OWNER)
(501) 666-5451
Entity
Organization
Contact information
Practice address
500 SOUTH UNIVERSITY AVENUE, SUITE 704, LITTLE ROCK, AR 72205-5309
(501) 666-5451
(501) 663-3335
Mailing address
500 SOUTH UNIVERSITY AVENUE, SUITE 704, LITTLE ROCK, AR 72205-5309
(501) 666-5451
(501) 663-3335
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
R2029
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54262
BCBS
AR
Enumeration date
05/01/2006
Last updated
11/16/2007
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