Basic Information
| Provider Information | |||||||||
| NPI: | 1407814940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELLINGER | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4200 N RODNEY PARHAM RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722122458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5015348888 | ||||||||
| FaxNumber: | 5015348891 | ||||||||
| Practice Location | |||||||||
| Address1: | 10018 WEST MARKHAM | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722052130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5015348888 | ||||||||
| FaxNumber: | 5015348891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 04/26/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 167 | AR | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00035400 | 01 | AR | RAILROAD MEDICARE | OTHER | DA2254 | 01 | AR | RAILROAD MEDICARE GROUP | OTHER | 136850717 | 05 | AR | MEDICAID |