Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | E-7188 | AR |
NPI | 1255637070 |
---|---|
Provider Name | Dr. Jeremy Garlick |
First Address | Little Rock, AR 72202-3500 |
Second Address | Little Rock, AR 72202-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2011 |
Last Update Date | 14/11/2011 |