Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | C4268 | AR |
NPI | 1093779787 |
---|---|
Provider Name | Lloyene Bruce-Reid |
First Address | Pine Bluff, AR 71603-7010 |
Second Address | Pine Bluff, AR 71603-7010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D04399 | (02) |