Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 2004014126 | MO |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | E-5994 | AR |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | E-5994 | AR |
NPI | 1376623165 |
---|---|
Provider Name | Dr. Patrick Lee Fraley |
First Address | Little Rock, AR 72225-1420 |
Second Address | Conway, AR 72034-8686 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 05/08/2021 |