Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | C7481 | AR |
NPI | 1003048943 |
---|---|
Provider Name | Lonnie E Harrison |
First Address | Malvern, AR 72104-4811 |
Second Address | Little Rock, AR 72211-3714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2009 |
Last Update Date | 19/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115615001 | (05) | AR |