Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | E-11903 | AR |
Y | 2080P0205X | Pediatric Endocrinologist | E-11903 | AR |
NPI | 1447699806 |
---|---|
Provider Name | Mr. Juan Diego Mejia Otero |
First Address | Little Rock, AR 72202-3500 |
Second Address | Springdale, AR 72762-0845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2013 |
Last Update Date | 14/09/2020 |