Provider Demographics
NPI:1639492549
Name:DR PAUL W ZELNICK PA.
Entity Type:Organization
Organization Name:DR PAUL W ZELNICK PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:W
Authorized Official - Last Name:ZELNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-666-3666
Mailing Address - Street 1:11400 HURON LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-1847
Mailing Address - Country:US
Mailing Address - Phone:501-666-3666
Mailing Address - Fax:501-666-2535
Practice Address - Street 1:11400 HURON LN
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1847
Practice Address - Country:US
Practice Address - Phone:501-666-3666
Practice Address - Fax:501-666-2535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104738001Medicaid
AR104738001Medicaid