Provider Demographics
NPI:1356834550
Name:ADVANCED ALLERGY AND ASTHMA PHYSICIANS PLLC
Entity Type:Organization
Organization Name:ADVANCED ALLERGY AND ASTHMA PHYSICIANS PLLC
Other - Org Name:ADVANCED ALLERGY AND ASTHMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-420-1085
Mailing Address - Street 1:500 S UNIVERSITY AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5304
Mailing Address - Country:US
Mailing Address - Phone:501-420-1085
Mailing Address - Fax:501-420-1457
Practice Address - Street 1:500 S UNIVERSITY AVE STE 215
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5304
Practice Address - Country:US
Practice Address - Phone:501-420-1085
Practice Address - Fax:501-420-1457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty