Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | R4062 | AR |
NPI | 1366454969 |
---|---|
Provider Name | Dr. Rheta Joann Horton Goatcher |
First Address | Little Rock, AR 72211-4316 |
Second Address | Little Rock, AR 72211-5805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 18/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
119064001 | (05) | AR |
E77728 | (02) | AR |