Provider Demographics
NPI:1215942198
Name:HENRY-TILLMAN, RONDA SHIRLETTA (MD)
Entity type:Individual
Prefix:DR
First Name:RONDA
Middle Name:SHIRLETTA
Last Name:HENRY-TILLMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST
Mailing Address - Street 2:SLOT 725
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-6503
Mailing Address - Fax:501-686-7861
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:SLOT 725
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-6503
Practice Address - Fax:501-686-7861
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE03632086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5K803Medicare ID - Type Unspecified
ARG70102Medicare UPIN