Provider Demographics
NPI:1225286883
Name:GREG M. ZAWADA, MD PLLC
Entity Type:Organization
Organization Name:GREG M. ZAWADA, MD PLLC
Other - Org Name:GREG M. ZAWADA, MDPA
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZAWADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-765-5655
Mailing Address - Street 1:PO BOX 241125
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0003
Mailing Address - Country:US
Mailing Address - Phone:501-765-5655
Mailing Address - Fax:501-313-5341
Practice Address - Street 1:2215 WILDWOOD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5089
Practice Address - Country:US
Practice Address - Phone:501-753-2424
Practice Address - Fax:501-753-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4895174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR175533001Medicaid