Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2606 | AR |
NPI | 1003903287 |
---|---|
Provider Name | Dr. Richard Gregory Elimon |
First Address | Sherwood, AR 72120 |
Second Address | North Little Rock, AR 72116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 08/07/2007 |