Arkansas Dermatology Clinic PA
Dermatology in Little Rock, AR. Organization (NPI-2).
NPI number1497713580
StatusActive
Last updated in NPPESNov 16, 2007
Details
- NPI
- 1497713580
- Entity type
- Organization (NPI-2)
- Legal business name
- Arkansas Dermatology Clinic PA
- Organization subpart
- No
- Enumeration date
- May 1, 2006
- Last updated
- Nov 16, 2007
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | R2029 | AR | Yes |
Practice location
500 South University AvenueSuite 704
Little Rock, AR 72205-5309
Phone 501-666-5451 · Fax 501-663-3335
Mailing address
500 South University AvenueSuite 704
Little Rock, AR 72205-5309
Phone 501-666-5451 · Fax 501-663-3335
Authorized official
Carl Joseph Raque
Physician Owner
5016665451
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