Provider Demographics
NPI:1184676538
Name:DERMATOLOGY GROUP OF ARKANSAS, P.A.
Entity Type:Organization
Organization Name:DERMATOLOGY GROUP OF ARKANSAS, P.A.
Other - Org Name:BRESSINCK, GIBSON, PARKER, SANGSTER, SMITH, BRUYNEEL DERMATOLOGY, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-227-8422
Mailing Address - Street 1:9601 BAPTIST HEALTH DR.
Mailing Address - Street 2:SUITE 690
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6328
Mailing Address - Country:US
Mailing Address - Phone:501-227-8422
Mailing Address - Fax:501-537-2399
Practice Address - Street 1:9601 BAPTIST HEALTH DR.
Practice Address - Street 2:SUITE 690
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6328
Practice Address - Country:US
Practice Address - Phone:501-227-8422
Practice Address - Fax:501-537-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR070003037OtherTRAVELERS MEDICARE#
AR132088008Medicaid
AR57735Medicare PIN