Byrum, Jerry Douglas
Byrum, Jerry Douglas is an sole proprietor health care provider with primary practice located at 904 Autumn Rd Suite 100, Little Rock AR 72211-3742. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Byrum, Jerry Douglas can be contacted via phone (501) 224-5437.Contact Information
Primary practice address
904 Autumn Rd Suite 100
Little Rock AR 72211-3742
Phone: (501) 224-5437
Fax: (501) 224-3473
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | C6800 | Arkansas |
Profile Details
| NPI number | 1194789685 |
|---|---|
| LBN Legal business name | Byrum, Jerry Douglas |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 13th, 2006 |
| Last updated | Nov 3rd, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194789685 | NPPES |
| Arkansas | Other | 11282000000 | QUALCHOICE |
| Arkansas | MEDICAID | 114501001 | QUALCHOICE |
| Arkansas | Other | 4208764 | QUALCHOICE |
| Arkansas | Other | 516264 | QUALCHOICE |
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