Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | E-4032 | AR |
Y | 111NI0900X | Internist | E-4032 | AR |
N | 2080P0201X | Pediatric Allergist | E-4032 | AR |
NPI | 1770673337 |
---|---|
Provider Name | Tamara Perry |
First Address | Little Rock, AR 72205-7101 |
Second Address | Little Rock, AR 72205-7101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 31/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L06402 | (02) |