Individual
JERRY DOUGLAS BYRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
904 AUTUMN RD, SUITE 100, LITTLE ROCK, AR 72211-3742
(501) 224-5437
(501) 224-3473
Mailing address
904 AUTUMN RD, SUITE 100, LITTLE ROCK, AR 72211-3742
(501) 224-5437
(501) 224-3473
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
C6800
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11282000000
QUALCHOICE
AR
05
—
114501001
—
AR
01
—
4208764
AETNA
AR
01
—
516264
HEALTHLINK
AR
Enumeration date
04/13/2006
Last updated
11/03/2011
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