Basic Information
| Provider Information | |||||||||
| NPI: | 1467448332 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DILES | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 S UNIVERSITY AVE | ||||||||
| Address2: | SUITE 505 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722055307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016644532 | ||||||||
| FaxNumber: | 5016634335 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 S UNIVERSITY AVE | ||||||||
| Address2: | SUITE 505 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722055307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016644532 | ||||||||
| FaxNumber: | 5016634335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2005 | ||||||||
| LastUpdateDate: | 12/04/2007 | ||||||||
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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 | 207L00000X | E-1168 | AR | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | E-1168 | AR | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | S04176 | 01 | AR | NOVASYS | OTHER | 17966000020 | 01 | AR | QUAL CHOICE (LRPM) | OTHER | 5K806 | 01 | AR | BLUE CROSS BLUE SHIELD | OTHER | 71033532430 | 01 | AR | QUAL CHOICE | OTHER |