Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2013-10-17
- Last updated
- 2013-10-17
Specialties
Licenses
- License AR
- PT3747
Location
- Practice location
- 1500 WILSON LOOP
- City
- WARD AR
- Postal code
- 721768656
- Phone
- 501-941-5630
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.