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MARYELLE GEORGETTE VONLANTHEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1515 S BOWMAN RD, SUITE B, LITTLE ROCK, AR 72211-4207
(501) 228-7171
(501) 228-5462
Mailing address
1515 S BOWMAN RD, SUITE B, LITTLE ROCK, AR 72211-4207
(501) 228-7171
(501) 228-5462

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
C8512
AR
208000000X
Pediatrics Physician
G9896
TX
2080P0206X
Pediatric Gastroenterology Physician
Primary
C8512
AR
2080P0206X
Pediatric Gastroenterology Physician
G9896
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
C8512
STATE LICENSE
AR
01
G9896
STATE LICENSE
TX
Enumeration date
01/25/2006
Last updated
07/10/2007
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