Provider Demographics
NPI:1306870068
Name:DRISKILL, ANGELA R (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:DRISKILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 15453
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72231-5453
Mailing Address - Country:US
Mailing Address - Phone:501-202-3638
Mailing Address - Fax:501-202-3639
Practice Address - Street 1:3333 SPRINGHILL DR STE 2002
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2922
Practice Address - Country:US
Practice Address - Phone:501-202-3638
Practice Address - Fax:501-202-3639
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0539207Q00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128765001Medicaid
AR5J857OtherAR BCBS
ARP00754987OtherRAILROAD MEDICARE
AR5J857G323Medicare PIN
AR128765001Medicaid