Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 1932191822 | AR |
NPI | 1144617465 |
---|---|
Provider Name | Mr. Michael Mcconnaughhay |
First Address | Benton, AR 72015-4848 |
Second Address | Little Rock, AR 72205-6205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2015 |
Last Update Date | 24/04/2015 |