Organization
BOYETTE FACIAL PLASTIC SURGERY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNINGS RUSSELL BOYETTE MD (OWNER)
(501) 205-8610
Entity
Organization
Contact information
Practice address
9601 LILE DR., MEDICAL TOWERS BUILDING 1, SUITE 970B, LITTLE ROCK, AR 72205-6321
(501) 205-8610
(501) 205-8610
Mailing address
PO BOX 241212, LITTLE ROCK, AR 72223-0004
(501) 205-8610
(501) 205-8610
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
E-7894
AR
Other
Enumeration date
05/23/2016
Last updated
05/23/2016
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