Russell Dermatology Of Conway, Pllc

LBN: Russell Dermatology Of Conway, Pllc
Russell Dermatology Of Conway, Pllc is an health care organization with primary practice located at 2425 Dave Ward Dr Suite 202, Conway AR 72034-8686. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as the primary health care specialty. Russell Dermatology Of Conway, Pllc can be contacted via phone (501) 328-5050, or through Russell, Jackie D via phone (501) 328-5050.

Contact Information

Primary practice address
2425 Dave Ward Dr Suite 202 Conway AR 72034-8686
Phone: (501) 328-5050
Fax: (501) 328-2131
Website:
Map and Directions
Authorized official contact:
Name: Russell, Jackie D
Phone: (501) 328-5050

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X E1574 Arkansas

Profile Details

NPI number 1639134067
LBN Legal business name Russell Dermatology Of Conway, Pllc
DBA Doing business as
Authorized official Russell, Jackie D
Entity Organization
Organization subpart 1 No
Enumeration date Apr 19th, 2006
Last updated Oct 9th, 2025 - about last year

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1639134067 NPPES
Arizona MEDICAID 140625002

Popular Providers