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
Fax: (501) 224-3473
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
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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