Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A005793 | AR |
NPI | 1043797087 |
---|---|
Provider Name | Sarah Gray-Staples |
First Address | North Little Rock, AR 72114-1709 |
Second Address | North Little Rock, AR 72114-1709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2018 |
Last Update Date | 23/07/2018 |