Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | E-8382 | AR |
N | 207L00000X | Anesthesiologist | 2012020960 | MO |
N | 208200000X | Surgeon | 2005-0262 | NM |
N | 208600000X | Surgeon | 2005-0262 | NM |
N | 208200000X | Surgeon | 2012020960 | MO |
N | 208600000X | Surgeon | 2012020960 | MO |
N | 2086S0102X | Surgical Critical Care | E-8382 | AR |
NPI | 1659410678 |
---|---|
Provider Name | Gerardo Tamayo Enriquez |
First Address | Little Rock, AR 72205-7101 |
Second Address | Little Rock, AR 72205-7101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 28/02/2017 |