Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | R3422 | AR |
NPI | 1003820036 |
---|---|
Provider Name | Dr. William Lyman Rutledge |
First Address | Jacksonville, AR 72086-2124 |
Second Address | Little Rock, AR 72205-2124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 21/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105362001 | (05) | AR |
B90544 | (02) | AR |