Provider Demographics
NPI:1265727259
Name:FOUR SEASONS ALLERGY AND ASTHMA CLINIC PA
Entity type:Organization
Organization Name:FOUR SEASONS ALLERGY AND ASTHMA CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:JEFFERS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:501-221-1956
Mailing Address - Street 1:11614 HURON LN STE A
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-1896
Mailing Address - Country:US
Mailing Address - Phone:501-221-1956
Mailing Address - Fax:501-219-2327
Practice Address - Street 1:11614 HURON LN STE A
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1896
Practice Address - Country:US
Practice Address - Phone:501-221-1956
Practice Address - Fax:501-219-2327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE6518207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty