Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | E12304 | AR |
Y | 2084N0402X | Child Neurologist | E-12304 | AR |
NPI | 1356769483 |
---|---|
Provider Name | Christopher Manbeck |
First Address | Little Rock, AR 72202-3500 |
Second Address | Little Rock, AR 72202-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2014 |
Last Update Date | 30/07/2020 |