Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | E-9703 | AR |
NPI | 1003159930 |
---|---|
Provider Name | Dustin Edward Williford |
First Address | Little Rock, AR 72202-3500 |
Second Address | Little Rock, AR 72202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2013 |
Last Update Date | 31/05/2018 |